Episode 27: Yesterday

First, the bad news. I went on to Netflix today and decided to count how many Grey’s episodes are left. What I found was upsetting, to say the least: I have 10 episodes left in season 2 (unbelievable! Seriously! This has been going on too long!), 25 episodes in season 3, 17 episodes in season 4, 24 episodes in season 5, 24 episodes in season 6, and 22 episodes in season 7! Go ahead, do the math: I have 122 episodes left and just over 100 days until my “breakup anniversary,” Valentine’s Day! So this means that today is the day that I am admitting failure. There is no way I can finish all of the episodes in less than 365 days. Like a Biggest Loser, contestant, though, some part of me wants to “finish.” And so, I trudge on, even though I have failed in my original task. Yes, I vow to keep watching episodes and blogging as long as I can keep it up.

On to "Yesterday." The narrative to this episode reads like they added it after the fact, because it bears very little relevance to what the episode was about:

Meredith: "After careful consideration and many sleepless nights, here’s what I've decided. There's no such thing as a grown-up. We move out, we move away from our families. But the basic insecurities, the fears and all the old wounds just grow up with us...for the most part, we're still a bunch of kids, running around the playground, trying desperately to fit in."

OK, except you're scrubbing in on surgery and writing orders for narcotics. I'm not saying this makes you a grown-up (the banter in the last orthopedic surgery I witnessed as a medical student enforced this fact. It was like hanging out with a bunch of junior high boys. Four hours of vibrator jokes. Attending: "Hey, why am I buying my wife a vibrator?" Resident: "I don't know. Why are you buying your wife a vibrator?" Etc. Four hours. I didn't know whether to laugh or cry.). No, what makes you a grown up is the episode you ran in season 1 that was all about how you're all grown up.

Anyway, the scene opens with Meredith serving her demented mother coffee in what may be the world's nicest nursing home. Let me say that Meredith's mother's dementia is like no dementia I've ever seen. She doesn't wander off or remove her clothes inappropriately or forget who her daughter is. No, her dementia seems to exist as a time warp where she is forever trapped in her intern year. If that doesn't sound like hell, I don't know what does, but she seems to enjoy reminiscing about call-room hookups and other hijinks. 

Nursing home? This looks like a Folger's commercial. Dementia should be so neat. This is dementia minus sundowning, incontinence, swallowing problems, atypical psychotic medications, and sad, confused, hollow eyes. And plus coffee. Although there's notably no evidence that people with dementia are actually unhappy. As my dementia researcher friend says, 'Ignorance really is bliss."

We move on to rounds, where Meredith presents the first medical mishap of the episode: “Stage 3 B non-small cell lung cancer. He has had extensive chemo and radiotherapy to which the tumor was not responsive. He is admitted for radical resection.”

Huh? I’ve never heard of such a thing. Stage 3B non-small cell lung cancer is defined as a tumor that has spread to distant lymph nodes, has invaded other structures in the chest (such as the heart or esophagus), or has a malignant pleural effusion (fluid build-up containing cancer cells between the layers lining the lungs). For the vast majority of patients, Stage 3 B is inoperable, especially after “extensive chemo and radiotherapy to which the tumor is unresponsive.” The other problem with this scenario is that other than his oxygen via nasal cannula, the guy looks as healthy as a horse. He doesn’t look like someone who has undergone “extensive chemo and radio therapy.” But…OK. 

"End-stage cancer patient" He looks healthier than me. Of course, he has removed his nasal cannula for this shot so you might be thrown off. It's amazing how far nasal prongs can go in convincing us someone is sick. It's the oldest nursing trick in the book. Me: 'He looks horrible." Nurse: "Yes, we just put him on 2 L to see if he would perk up."

I'm not complaining too much because operating on inoperable lung cancer is NOTHING compared to the other major medical plotlines in this episode. The first is a woman who is having “spontaneous orgasms.” I guess that spontaneous orgasms are not unheard of (apparently, it’s called Persistent Sexual Arousal Syndrome or PSAS. The link might make you think it's a real medical entity, but note that the link references an article in Playboy called, "The Woman Who Could Think Herself Off," so I’m not sure it’s considered “class IA” evidence in the medical world.) The bigger crime is that the surgeons of Grey’s take this woman to surgery! For what, I ask? What might they possibly be surgerizing? Brain? Genitals? Your guess is as good as mine. The writers don’t even attempt to explain the surgery because there is no possible medical explanation. (My favorite piece of the puzzle is that at one point, Izzie seems to be doing a prenatal-style ultrasound on the patient, for unclear reasons).

The best thing about this plotline is that I was watching this scene when GF walked into the room, saw the woman moaning, making faces and pointing her toes. GF looks at the screen, looks at me and says, "So, what's going on here?" I answered, "Oh, that patient is having spontaneous orgasms." To which GF answered, 'Of course she is," and then turned and left the room.

And then there’s the most ridiculous plot of all-Mark Sloan is back in town, and creating havoc every way he can. He’s cute, for sure, and he immediately hits on Meredith:
 
MARK: "You and I are the dirty mistresses."
MEREDITH: "I suppose we are. Why do you think that is?"
MARK: "My $400-dollar-an-hour shrink says it’s because behind this rugged and confident exterior, I'm self-loathing and self-destructive to an almost pathological degree."
MEREDITH: "We have a lot in common." 

This is what seeing a cute television plastic surgeon will do to a bunch of television interns. In real life, it's much more awkward.

CRISTINA: "McSexy?"
MEREDITH: "That's not right."
IZZIE: "McYummy?"
CRISTINA: "Mmm... no."
MEREDITH: "McSteamy."
CRISTINA: "There it is!"
IZZIE: "Yup."
GEORGE: "Allow me to choke back some McVomit.

And Mark is trying to win back Addison.

Although Addison is displaying the universal symbol for "Stop, your cologne is overwhelming, your scruff is too calculated, and you just hit on the woman my husband used to sleep with," Mark is still thinking he might score.

Worst of all, though, Mark arrives in Seattle from New York and immediately begins practicing medicine without a license. He offers to perform some kind of facial reconstruction to a patient with Craniodiaphyseal dysplasia, also known as “lionitis” also known as the “disease that made Eric Stoltz famous for his role in the movie Mask.”

Before the facial reconstruction even starts, though, McDreamy kills the kid with a brain-surgery botch that results in a fatal hemorrhage. Mark then completes the facial reconstruction on the now-dead kid. I wonder if they got the family’s consent for that one?

Geez, Eric Stoltz has not aged a day since "Mask." All this episode was missing was Cher.

In other character development news (literally, nothing has happened all season and now suddenly it’s all happening in one episode!), Meredith tracks down her father (who appears to be the parent from whom she got her weeny, whiny, wet-blanket personality. Still, he doesn’t seem like a bad guy, so why hasn’t she seen him in 20 years? Parental visitation doesn’t exist in this world?) and George confesses his love to Meredith, finally, and although we all know that she’s not that into him, it looks like she might make a mistake and sleep with him.

GEORGE: [to Meredith] "Hi. I... I know I'm not a world-renowned surgeon, and... I know I'm not a lot of things you've gone for in the past. I know that. But... I would never leave you. I would never hurt you. And I will never stop loving you."

You didn't hear me wrong. That's not Tom Cruise and Kelly McGillis in "Top Gun." That's George and Meredith.

Now this one IS Tom Cruise and Kelly McGillis. I remembered this shot as vertical but it looks horizontal here.

Most interestingly, George and Burke give their beloved women almost the same monologue without either hearing the other deliver the speech. Quite a coincidence, don’t you think?

PRESTON: [enters his apartment] "I am Preston Burke. I am a widely renowned cardio-thoracic surgeon. I am a professional and moreover I am a good, kind person. I am a person that cleans up after himself. I am a great cook. And you? You are an unbelievable slob. A slovenly, angry intern. I am Preston Burke. And you... are the most competitive, guarded, stubborn... the most challenging person I have ever met. And I love you. Why the hell won't you just let me?
CRISTINA: "I gave up my apartment 20 minutes ago."
PRESTON: [pauses] "Well, alright then."

And the moral:

“I've heard that it’s possible to grow up. I've just never met anyone who’s actually done it. Without parents to defy, we break the rules we make for ourselves. We throw tantrums when things don’t go our way. We whisper secrets with our best friend in the dark. We look for comfort where we can find it. And we hope against all logic, against all experience. Like children, we never give up hope.”

Huh? I think this refers to George “taking a chance” with Meredith, but truthfully, given George’s unrequited love, the moral maybe should be, “There are some times when giving up hope is your best option.” (Like when you have 122 episodes and less than 100 days.) Feel free to propose other alternatives to this moral in comments.

Although...and not to give the writers too much credit here, but...OK. I have a new reader, someone who knows me in real life, who has taken hope from this blog. She read the first entries, saw how unhappy I was, and realized that I'm so much happier today, just 260-some days after those first sad narratives. So...maybe, sometimes, it's OK to hope? I don't usually let such drivel slip by, but I (and this blog) may be proof that sometimes, hope is (Don't say it. Don't say it. Don't say it.) just what the doctor ordered. (Oh, God, you said it.) Yeah, I'll hear it for that one. Somewhere in surgeryland, Dr. McAwesome just threw up a little bit..

Episodes 25 and 26: It’s the end of the world (as we know it)

[to be sung to the tune of “It’s the end of the world as we know it (and I feel fine)" by REM. My advice? Push play on the video and read the post below along with the music]:

Dreamscape complete with teary haze.

That’s great. It starts with a dreamscape, OR craze, and

teary haze. Meredith is quite afraid.

Premonitions, death dreams, gratuitous lesbian shower scenes,

Screaming woman, chest wounds, Bailey’s water broke on George’s shoes,

Ricci’s hand into the chest

Bleed, where bombs sleep

The ORs start to clatter with fear, fright, flight, hype

Car wreck and a head bleed, Bailey’s hub to OR 3, neurosurg emergency with

A bomb on site

Alex is a-coming in a hurry with a fury not to

move that hand

Team by team the surgeons baffled, trumped, tethered, cropped

Look at that chief reign

Fine, then,

Uh-oh, trombones, drums roll, change of tunes from indie tones

“Save yourself, Save yourself!”

But what does Bailey’s husband need with that subarachnoid bleed

McDreamy sticking with the husband cause it’s right. Right.

Izzie idiotic, in a closet with that Alex who is feeling pretty psyched

It’s the end of the show as we know it.

It’s the end of the show as we know it.

It’s the end of the show as we know it.

It jumped the shark.

40 minutes/TV hour. Next week we’ll have Nielson Power.
We know you will return to see if all the ORs burn
Scrubbed in, bomb holding, silly plot is still unfolding,
Every move could escalate, subsequent incinerate
Lots of drama, lots of tension. Hold still, hold still,

Watch your hand rush, rush. Uh-oh, this means no fear, Meredith.
Who will you end up with? Season after season after season after you will pine, yet:
“Offer me solutions, offer me alternatives and I decline.”

It's the end of the show as we know it.
It's the end of the show as we know it. (It's time I had some time alone)
It's the end of the show as we know it (It's time I had some time alone).

It jumped the shark.

It's the end of the show as we know it. (It's time I had some time alone)
It's the end of the show as we know it. (It's time I had some time alone)
It's the end of the show as we know it (It's time I had some time alone).

It jumped the shark.

It's the drama for our times, residents with crazy lives. 
Everyone else makes it but the 

Bomb Squad Guy dies?
Christina Ricci, Meredith and Preston Burke.

Bailey's husband, Alex, Sandra Oh! Whoa!
Egoistic, narcissistic, G.A. cast.

Right? Right.

It's the end of the show as we know it. (It's time I had some time alone)
It's the end of the show as we know it. (It's time I had some time alone)
It's the end of the show as we know it (It's time I had some time alone)

And I feel fine.

Gratuitous lesbian shower scenes

Bailey's water broke on George's shoes. She does not yet know that her husband, after a car wreck on the way to the hospital, would soon be Derek's patient

Christina Ricci guest starring as a paramedic who puts her hand into a patient's chest wound. A chest wound that contains a bomb. Yes, that is Christina Ricci's hand, displaying the true meaning of the phrase "The opposite of sex."

If I had a nickel for every Xray with a foreign object that they've displayed on this show...I'd have at least a dollar.

Izzie idiotic, in a closet. Alex is feeling pretty psyched.

Offer her solutions, offer her alternatives, and she declines.

Maybe my take was a little harsh, but these episodes do seem to represent the weeks the show jumped the shark. The plot is ridiculous, unbelievable, and far afield from the "medical drama" this show was supposed to be. To me, the question is not "has it jumped the shark?"  but "Can it rise from the dead?"

For those who missed it, the episode ends like this: the bomb goes off just outside the OR and everyone is somehow fine except the bomb squad guy, who is dead. To indicate all that Meredith has been through in this day, in the last scene they give her a neat little scratch on her forehead. Never mind that she was 30 feet from a bomb blast that showered her with debris and the force of which slammed her head against the floor incredibly hard. 

The TV version of a traumatic experience = a neat little scratch.

Episode moral: If you knew this was your last day on earth, how would you want to spend it?

My answer: I don't know, but definitely not watching this show. 

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.

Episode 23: Tell Me Sweet Little Lies

The silence in response to my last post was absolutely deafening. To date, I have received zero comments. How could this be? I’ve asked around, I’ve done the math, and I have a few explanations. 1. “This is what happens when you don’t post regularly.” True. Although I still have readers (unless all those hits are me, a possibility that I’m not totally ruling out), it does seem that I’ve lost a good percentage of my following by not posting regularly this summer. 2. The second, scarier, but probably more likely reason that the comments have fallen off so precipitously: “Uh..it wasn’t your best work.”

This second answer was not much better than the response I got after a night of disastrous Karaoke in 2007. You can read all about it, but to sum up: After I performed what was the most unfortunate karaoke number in the history of really bad lesbian bars (and people, that is saying something), I confronted my "friends" for failing to support my (admittedly disastrous, train-wreck, but still my) karaoke effort in any way. I mean, shouldn’t your friends at least clap for you after you went through the trouble to sing in front of an audience of hostile strangers? After a minute or so of awkward silence, one of the group answered with, "Well, I don’t really consider you a friend.” Or something like that. What does this have in common with “Well, it wasn’t your best work?” Both are harsh. And both are probably true.

In my defense, the last episode was nobody’s best work. It rehashed a stale, overdone plotline without including much new material or any good one-liners. It was filler, and it was obvious it was filler, and maybe that led me to be OK with leaving the last entry of this blog as filler, and my readers (note: I am back to calling you readers instead of fans) could smell mediocrity from a mile away. For this, I am sorry. Or maybe I’m not sorry. Although I’m the one watching and writing about these crappy episodes, I’m glad that when the content of the blog is boring or worse, just bad, people don’t waste their time trying to think of something to say. Plus, I know that some of you are really my friends, so much so that you’re kind enough not to say anything when a post just isn’t good. I’ll admit I shouldn’t have put the 9/11 stuff in there. It was cheesy, and I knew it, and I still included it, like I was writing for the New Yorker or something. Maybe instead of bitching about the lack of comments, I should be thanking you for not saying anything mean.

Of course, there is another possibility, one that is some ways much worse: Perhaps I have neglected this blog so terribly and for so long that no one read that last post. It’s clear that we have reached the point of this show where the novelty of my blogging about it has worn off. It’s hard to make fun of the same, dead-end plotlines again and again. Nothing seems to have happened this entire season. Plus, I started this blog because of a breakup, and that breakup is long over. So maybe it’s time to call it a day on the blog. If it’s not making my readers happy, then what’s the point?

And yet…Am I over the breakup? I feel like I am, except in the sense that no one ever TOTALLY gets over a bad breakup-it’s a scar…or maybe more like a tattoo. It’s there. It doesn’t hurt so keenly, but I’m left, staring at the thing, and still wondering about the same thing I was wondering about in March: Am I at risk of just making the same relationship mistakes again and again? Because if so, I need some therapy, or maybe even a miracle cure.

Which brings us to today:

This episode, named after a Fleetwood Mac song, is really all about Cristina Yang, which makes it the best episode I've seen in a long time. As the title would indicate, the theme is:

“Our patients lie to us all the time. The rule is: every patient is a liar until proven honest.”

First, I don’t think this is true. I don’t think my patients are liars. I think patients, for the most part, tell the truth, and I think most doctors would agree with me. The only patients I don’t believe are the patients who have positive tox screens but SWEAR that they don’t do drugs. Liars. Every one. Other than that, do I have any reason to think that you’re lying about your history of hypertension and hypercholesterolemia? No.

“We lie to ourselves because…the truth? The truth freaking hurts.”

There’s a patient who is a guitar player who unfortunately gets his fingers cut off in some sort of stage accident. Even more unfortunate, the only hand surgeon on staff is…?McDreamy?  Even my humanities-oriented girlfriend picked up this. She watched him sewing the guy’s hand and asked, “Isn’t he a brain surgeon?” Why yes. Supposedly. 

Since when is McDreamy a hand surgeon, you ask? I don’t know, but I wouldn’t trust any neurosurgeon to reattach my severed fingers. (Well, I'm really hoping I'll never have to have anything reattached, but you know what i mean)

Alex is taking care of a competitive eater with an esophageal tear, and this inspires a pretty funny hot dog eating contest among Cristina, George, and Alex. Cristina uses the water on the buns trick and wins the contest:

But loses her cookies after the fact:

And this is why we love Sandra Oh! She's hot, and a touch butch, but not so hot that she'll refuse to do this scene or a scene where she stuffs her face with a hot dog.

In other Cristina news, Cristina lied to Burke, telling him she moved in with him when she actually kept her apartment.

Meredith: Truth. Did you move in with Burke or not?
Cristina (sighs): I told him I moved in with him. I’m keeping my old apartment. (Meredith gives her a look) What? I sleep with Burke every night. My clothes are there. So I still have my apartment, big deal.
Meredith: You have to tell him.
Cristina: Actually, I don't.
Meredith: So I’m supposed to go to dinner at your fake apartment with the guy you fake live with?
Cristina: Oh, I would never have you over to dinner with Burke. That’s weird.
Meredith: This is my point. Stop with the lying.
Cristina: And you’re being honest? That last time you called him Mc Dreamy you were all a-twitter with love.
Meredith: We're just friends.
Cristina: Uh huh.
Meredith: We are.

Really, Cristina is having quite an episode:

Cristina is so right: Why is this neurosurgeon always in elevators with interns? Creepy.

Derek: What is your problem? I’m your boss. What’s the matter-

Cristina: No you’re not my boss right now. We’re in an elevator. That’s your specialty, right? McDreamy moments in elevators?
Derek (warningly): Dr. Yang...
Cristina: You know what, for a moment, I’m not Dr. Yang, and you’re not Dr. Shepherd. You’re the guy who screwed up my friend. The guy who drove her to get a dog she can’t keep, a dog she only got because her boyfriend lied to her about his wife.
Derek: I never lied to her.
Cristina: You know what? I know a liar when I see one, ‘cause I’m a liar. Fine you want me to lie to the patient. I’ll lie.

Bailey is having Braxton hicks contractions, leading Addison to tell her to stop working so hard.

There’s a patient who refuses to leave after being discharged:

George: “If she refuses to leave, what am I supposed to do?”

Chief: “She’s 78 and non-ambulatory. You have the upper hand. Use it.”

But George fails to get her out, and when the chief catches him doing her errands,  

George asks: “Have you met Mrs. Larson?”
Chief: “Why do you think she’s been here so long? In a private room? We can’t keep her. Not on the surgical service.”

This inspires George to spend the rest of the episode trying to transfer this patient to another service, an act that is known in medicine as:

The Turf.

The turf has long been touted to interns as one of the keys to success in hospital-based medicine. Learn how to turf your patients to other services and save yourself some pain, says the conventional wisdom. The concept existed before the book House of God, but was no doubt immortalized because of that book. HOG (which contains such “golden” rules as “GOMERs go to ground,” “They can always hurt you more” and “The only good admission is a dead admission”) was only following its own rule (“Rule #5: Placement comes first: Your absolute first question should be: ‘How am I going to TURF this patient?’”) when it provided very specific instructions on the best methods for turfing patients, including raising the bed to heights where your poor, confused aged patient is likely to fall off and experience trauma as a result of the fall. There is “orthopedic height” (Fall and break a hip, get turfed to ortho) and “neurosurgical height” (fall off, head bleed..turf to…well you get it). Of course, these days, patients with these problems stay on the hospitalist service with only the briefest of surgical consults, so such escapades are no longer beneficial to the primary team (and they were, ahem, never beneficial to the patient). More often than not, it’s hospitalists who complain that surgeons turf to medicine. It’s common practice for surgeons to refuse to take a patient onto their service because of “complex medical issues” (i.e., comorbid diabetes or hypertension).  Despite the grumbling about surgeons refusing to care for their patients, however, there is a practical side of this: surgeons are busy operating and taking care of post op patients and they don’t always have the time or knowledge to take care of the medically ill. In fact, I have recommended in my own institution that hospitalists should volunteer to care for most of the patients in the hospital, with surgeons only consulting-which frees the surgeons up to be in the OR. Of course, the danger is that hospitalists end up perennial interns, always taking care of somebody else’s scut and never getting any respect. Plus, I don’t think there’s any way hospitalists would be paid for this service directly-the hospital would have to figure out dollars saved by adding extra surgeries-which they’ll never, ever do. Hospitalists are already criticized for “Not making the hospital any money” and even "costing the health care system too much" (just like palliative care never makes money-until you figure that they talk to families and convince them to take terminal patients off ventilators days, weeks, or even months earlier than if the palliative care team wasn’t there. But nobody ever counts that cost saving as income), so I can’t imagine hospitalists caring for the entire hospital would be a popular option. But it makes clinical and, thinking out of the box, even financial sense.

After multiple TURF attempts, George finally discharges the patient to a nursing home.

There was one pretty good line that I am too PC to ever use but still made me chuckle:

Chief to nurse administrator: “Don’t you speak nurse?”

And, finally, the moral (just to irk those who don't like morals):

“No matter how hard we try to ignore or deny it, eventually the lies fall away, whether we like it or not. But here's the truth about the truth: It hurts. So we lie.”

Episode 22: Begin the Begin

This is the birthday edition of the Miracle Cure. Yes, I turned 37 last week. 37 is not quite old, but is certainly no longer young. I think one could make the argument that 37 years is the beginning of middle age, making it not much of a birthday to celebrate. When I started this blog, I think it was my fear that I would reach this birthday single, childless and with minimal job security. On the up-side, I’m no longer single.

On a happier note, a big birthday shout-out to Dr. McAwesome, my favorite surgical intern!!!! (I think she may now be 25. Or maybe 26). Congrats on getting through your first three months.

“Fresh starts. They happen every year. Just set your watch to January.”

This is Meredith’s introduction to the Grey’s version of the 80-hour-work-week. The chief touts it as a needed intervention to reduce errors, although the New York Times recently reported that reducing errors and improving quality in medicine is much more complicated than reducing work hours alone.

What the show seems to miss is that 80 hours is still a lot to work, and doesn’t usually involve leisurely, untired mornings off. No, 80-hour-work weeks usually just mean that most days are a regular 8-10 (and sometimes 12) hour-work-day, twice a week is a 16-hour (or longer) day, and one day a week is 24 hours off. I worked 80-hour-weeks for two years of my residency, and I found I was at work during most daylight hours. When I finally got home at night, I was freakin’ tired, just able to eat dinner and watch bad TV. Far from leaving residents with many leisurely daylight hours free, the 80-hour-work-week turned residents from complete zombies with swollen, haggard faces and a confused, psychotic look into normal tired people who could occasionally go out to dinner. (Although, as my friend who is a program director said to me, "Even with the 80-hour-work-week, intern year does a number on these folks, that's for sure. We see the class pictures of the interns versus the second years and there is a significant difference. The second years have aged. Of course, we don't tell them that.")

In stark contrast, the Grey’s residents in this episode appear to working a 20-hour (or even 10 hour) week, because their new schedule lets them live the lives of stay-at-home-dog-owners and freewheeling retirees. They do laundry and bake things and go jetting across the country on a whim (well, Cristina jets off with Bailey to Idaho to get a heart for a transplant. Meredith runs into McDreamy during a leisurely morning at her mother’s nursing home. Meredith also does laundry and makes muffins.) This depiction is, of course, ridiculous and may have contributed to the belief held by a large number of attendings who insist that residents “can’t learn anything” in 80 hours. To me, working 80 hours a week for 3-7 years in a structured training program should teach a person how to be a doctor. If it doesn’t, there’s something wrong with the training program, not something wrong with the hours.

The Grey's version of the 80-hour-work-week=stay at home dog owner, spending leisurely mornings doing laundry

Or, perhaps, living the life of a jet-setting retiree

In other Grey’s news:

The dog is not working out. He barks, urinates, and tries to mount George from behind.

Addison hates McDreamy’s trailer.

Burke still wants Cristina to move in. Cristina is still deciding. (I am so sick of this ridiculous plotline)

A patient who is awaiting a heart transplant hits on Izzie. He looks pretty realistically pale and puffy but not quite short of breath enough. I found that I couldn’t stop wishing he would be a little more short of breath so he would just stop talking. Spoiler alert: he doesn’t get the heart.

Bailey seems unhappy. It may be the 80 hour work week or may be the fact that she is very pregnant. She’s one of these “'work hours ruined medicine' people.” Her stance reminds me of a residency interview I had with a very tired and scary-looking chief resident in Seattle. It was before the 80-hour-work-week was around, but some programs did have “caps” on admissions. This meant that after a certain number of patients, a resident was “capped” and couldn’t do any more work. In the course of my interview, I asked, “So do you have an admissions cap here? Or how does this program limit the residents’ workload?” It was a pretty benign question, but the woman suddenly developed a facial tic and loudly and forcefully announced, “Any program that limits the number of admissions is a program where you will learn NOTHING!” Needless to say, I left the interview feeling like the program was not a good fit for me.

A man ate his book and needs it to be surgically removed. “I ate the whole damn thing. Every last piece of that unmitigated crap.” It comes out of his gut in the OR as a bloody lump, but the patient remains ill. Alex somehow figures out that the man has mercury poisoning. Good catch, although unlikely that you would have figured it out, particularly given the fact that you didn’t even know about central pontine myelinosis.

Poor Jamie Lee. Constantly with the gender rumors and she has to do those commercials touting yogurt for chronic constipation.

This episode also raises the age-old question: Does Jamie Lee Curtis have a Y chromosome? Well, let me rephrase. Jamie Lee Curtis is not mentioned in the episode at any point, but a patient in this episode presents with a disorder that Jamie Lee is rumored to have: Androgen Insensitivity Syndrome. This syndrome occurs in people with XY chromosomes who are unable to respond to androgens, so despite the male genetics and the presence of testes (and the resultant androgens these testes secrete), the patients appear phenotypically female. The patient in this episode was raised a girl but she is supposed to be a tad boyish-if you've seen the episode but are still slow on figuring this out, I will clue you in: the patient's boyishness is indicated by the fact that she insists on being called “Bex,” she doesn’t have a boyfriend, and she wears a winter hat at all times. 

Winter hats: indicator of gender identity questions?

Addison biopsies a “growth” on Bex and pathology (always available minutes after the surgery!) reveals it is an undescended testes. In response to this finding,  Bex’s parents don’t want her to know, but George reveals the secret to Bex, and by the end Bex is cutting her hair short. (Because short hair and gender identity issues go hand in hand, right?).

Or is it the short hair?

Once again, this plot line isn’t supported by evidence. There’s no evidence that patients with androgen insensitivity who are raised as women are more likely to be transgendered or gay-which means Bex’s testes probably aren’t doing much to contribute to her gender identity problems (although it could be an independently occurring event, I guess. True, true, unrelated, as they say. Or could the hat be causative?). In one of the more interesting moments of the episode, George gives Bex a lecture, advising her that her issues with bullying at school will end when she goes to college. His point? “It gets better.” This episode was broadcast long before Dan Savage et. al. created “It gets better,” making me think that that Dan saw this episode and unconsciously incorporated its message into a website he created 5 years later. So thank you, Grey’s writers, for (maybe) saving the lives of a few sad gay teens. Although…George is played by the one gay actor on this show, T.R. Knight. Our friend T.R. was reportedly bullied on the set by the actor who plays Burke, Isiah Washington. 

So sometimes it gets better and sometimes, even when you grow up and many of your dreams come true, you still have to deal with complete assholes at work.

ER actually had a patient with androgen insensitivity syndrome as well, although they presented it in a slightly more sensational manner, ending the scene with an attending surgeon saying to the resident (after she informed the family of the situation), “You handled that very well...... but you should have told them they're going to have to change their daughter's name from Barbie to Ken."

Uh, except they’re not and that statement is totally offensive. Annoying.

Last note: I was coming back from a conference today, Saturday, September 10^th, and I happened to take the train, which meant that I got to see the best view I ever get of the Manhattan skyline. It reminded me of the first time I saw the skyline after September 11^th-a moment in which I suspected that I would never again see that view without my first thought being that the towers were gone. 10 years later, that is still true. Weirdly, as the scenery whizzed by, I also happened to be listening to this Death Cab for Cutie song (yes, I know, DCFC is so 2005. My IPod was on shuffle.) which seemed so fitting: 

“I wish we could open our eyes
To see in all directions at the same time
Oh what a beautiful view
If you were never aware of what was around you”

Death Cab for Cutie, Marching Bands of Manhattan