Episode 6: If tomorrow never comes

Well, I must admit that this was quite a bad week. I was still on service, and my week consisted of arguments and difficulties with surgeons and consultants, and ended with me giving feedback to a medical student who spent the entire meeting crying. I felt bad, but I wasn't saying anything all that inflammatory. I was merely trying to make her a better doctor and I was nice about it. I swear.

But back to Grey's. After seeing Grey and McDreamy making out in a car, Grey's resident is intent on not letting McDreamy favor Meredith. I find this plotline dull, but not nearly as dull as George's ridiculous crush on Meredith. For one, his hair is terrible. I can't possibly take someone with this haircut seriously. Sadly, my hair looked a lot like his until 1:30 today when I finally got it cut. It's shorter now, and more shapely, I hope.

A good portion of the episode centers on a woman with a 60 pound tumor who is being cared for by Frat Boy until he accidentally leaves a microphone on while the patient is getting a CT scan and she overhears him wondering how she ever let a tumor get that large. It's a reasonable question, but as a doctor who was nearly crippled from rheumatoid arthritis before I finally broke down and saw a rheumatologist, I can understand how these things get away from a person. Ex is a doctor, too, and it was nearly two years of me saying "My hands were so stiff this morning but seem to be better now" before she finally said, "Do you possibly have RA?" Even then, I said, "No way. No way." Her response: "Yeah, no way. (pause) You know, if you have fibromyalgia, we're breaking up." 

In contrast to the character in the show who was afraid to seek help because she was sure she was dying, Ex was trying to say (in a very unpolitically correct and now-ironic way) that her fear (and, honestly, my fear, too) was not that I had a horrible illness but that what was wrong with me was going to be of unclear etiology. I was so scared that I had developed some chronic pain condition without a clear pathology that I didn't want to see a doctor. Getting a diagnosis of a serious disease sucked, but on some level it was a relief to not be "crazy." As Meredith says in this episode, "Sometimes, knowing is better than wondering."

Seeing Ellen Pompeo in jeans for the first time was a truly scary sight. Please, someone, hand that girl a sandwich. Her legs are like little toothpicks.

Two medical points to be made:

1. Burke says to Frat Boy, "You are 60% more likely to be sued if you’ve offended a patient" This has actually been studied: I couldn't find the 60% number, but respondents were more likely to sue if the communication from providers was unsatisfactory for the patients, particularly if no assurance was given that the mistake would be prevented in the future. 

I definitely use this theory for working with my patients-I made a special effort this week to spend time explaining things my patients who'd had problems because I believe that schmoozing/reassurance makes a difference. If I'm wrong, I'll have at least made the effort.

2. The cardiac surgery outcomes in this hospital are truly terrible. This is episode six. In episode 1, a CABG patient died; in episode 5 a patient ruptured her heart wall, bled into her chest, and had to go back to the OR. In this episode, a patient developed tamponade and PEA post op. Turns out that CABG outcomes are now published for many hospitals. If Seattle Grace, were a real hospital, it would likely not look as good as its competitors.

Best quote:

“Seriously? You’re equating your  pathetic lovelife with my record-breaking tumor? Seriously?”

Episode 5: Shake Your Groove Thing

I believe the show hit a stride for the first time in this episode. Ellen Pompeo, Dr. Grey, establishes herself as a Class A whiner (albeit the worst kind of whiner: a whiner with real problems). In addition to the whining that is written into the script, she clearly has an upper respiratory tract infection the whole episode, which adds to her ability to make herself into a very convincing surgical intern. (I remember, as a medical student, seeing this pale, ghostly, exhausted-looking figure buying a falafel from a Middle Eastern takeout. For a moment, I thought he was a drug addict, but on second glance I realized he had been my surgical intern. I pointed him out to my friends and said, “That sad sack there is what a surgical intern looks like.” (Sorry, Dr. McAwesome. Hopefully the 80 hour work week will prove my understanding of surgical internship to be old-fashioned.)

 A pretty convincing surgical intern, of the anorexic/whiny variety (other options include: angry, over-caffeinated, addicted, exhausted, UNDER CONTROL, anxious, and arrogant)

In addition to the realism added by Pompeo's URI, the episode does a good job of capturing the crazy feeling of being "post-call" (as in, "I'm post-call," meaning that you you've just completed an extremely long shift). Post-call, the likelihood of making bad choices drastically increases. In this episode, Post-call Grey merely gets drunk at Izzie's ridiculous party and then gets caught (by her resident) while making out in a car with Dr. McDreamy. (Interestingly, my previous statement about attendings and interns making out in the hospital parking garage was not so far off: Premonition….) In my case, I completely lost my mind six months into residency and didn’t get it back until 6 months after residency was over. The result was much less glamorous and much more complicated than Dr. Grey: by the time I woke up from my residency-induced haze, I was thirty-five pounds heavier than when I started, newly broken up with my partner of 9 years, and the most depressed I have ever been in my life. And I'm not even a surgeon. (FYI: I've lost 20 of those pounds. The last fifteen, though, are killer.)

But back to Grey's:  Although a good chunk of the episode centers around a party that looks about as fun as those horrible parties I used to go to during high school and medical school (Notice I don't mention college, because college parties were actually fun.), it more importantly asks the question: Does being a doctor mean you are an adult? If this episode is to be believed, it seems like it does, because it changes your priorities in a way you never thought possible (sort of like being a parent, I guess). So, is it so bad to be all grown up? I have honestly struggled with this question my entire adult life, and, like Meredith Grey, I have also finally decided that “Adulthood has it perks,” although, her reasons include “great sex, expensive shoes, and no parents telling you what to do.” For me, great sex is but a memory, I would look ridiculous in expensive shoes, and I totally like my parents and wish they lived closer to me. My reasons for liking adulthood are more like this: in the end, having a job and car and your own house and being able to make what you want to make for dinner, being able to hire people to do household jobs you don’t want to do, and, very occasionally, being able to stay out late, are all worth the pain of paying taxes, having to go to work every day, and dealing with the prospect of single parenthood. (hmm..not so sure about that last one. Will get back to you on that.)

Random notes on this episode:

1. There is more "attending on intern hot hot action." The attending is the horrible Isaiah Washington, a person I can’t even think of a mean nickname for given that his quote on the red carpet at the Golden Globes was a sarcastic, “I love gay. I wanted to be gay. Please let me be gay.” He lost his job over that, but not for ! two more painful seasons. Worse luck, he hooks up with the hottest person on the show (currently) Dr. Cristina Yang, played by Sandra Oh!, who had quite a good turn as a pregnant lesbian who was abandoned by her partner in Under the Tuscan Sun. So disturbing.

2. These surgeons eat more than any surgeons I’ve ever met. My surgical chief resident used to drink a skinny iced latte for breakfast and a diet coke for lunch. Thank god I never ate dinner with him. 

3. Guest star of the week. Kathryn Joosten

Best known for her role as Mrs. Landingham, the President's secretary, on the show The West Wing, in this episode of Grey's, it is revealed that Dr. Burke accidentally left a towel in her chest a few years ago, and she's been feeling crappy ever since. The episode focuses on the fact that he eventually comes clean about that darned towel and apologizes to the hospital and the patient, but I feel obligated to point out that this towel-thing is a surgical Never Event. In other words, it's one of those things that should NEVER happen. A recent New England journal article estimated, however, that there is about one case or more each year of retained surgical objects in a typical large hospital. It's not that towels weren't counted in those cases, either. Most of the time, counts were performed, and 88 percent of the time the final count was erroneously thought to be correct. The authors conclude, "These findings suggest that screening of high-risk patients at the end of operations should be considered even when counts are documented as correct." There are new initiatives being considered to deal with this, such as radiolabeling towels used in the OR. Anyway, sorry Mrs. Landingham. It's no wonder you died on the West Wing, what with a towel in your chest and all. 

4. Have you noticed I'm rocking the screen shots in this post??? This is a seriously important day for me!

5. Best Quotes:

“I’m older than I look”

God, if I had a dollar for all the times I actually said this to patients who have told me that I"m not old enough to be a doctor, I'd be in less credit card debt than I am now.

 "I do research now, and I have a life. A family."

I also do research, but have no family and no life. I don't blame medicine or research for that, though. I'm pretty sure it's my own fault.

“We are workaholics with god complexes”

So true.

“We’re adults. When did that happen? And how do we make it stop?”

 "Responsibility. It really does suck."

Episode 4: No Man's Land

Oh, dear God. Let’s start with the name of this episode. I once saw a pornographic videocassette with this exact name. I vaguely remember horrible, long, fake fingernails and a lack of hair where hair is meant to be. In other words, this episode and I started out on the wrong, uh, foot.

Plot points:

Izzie struggles to help a patient who is getting a prostatectomy. He doesn’t want her in the room for the surgery because of her recent stint as a “Bethany Whisper” underwear model. Despite this, Izzie eventually saves the day after the urologist, “Limp Harry,” initially refuses to do a nerve sparing procedure because it would take “almost an hour longer” and he might miss his tee time. To right this injustice, Izzie storms the OR, demands that the nerves be spared, and chides the urologist for not planning to do so in the first place. This would be both heroic and compelling if only there were some medical truth to it (see “Lessons Learned” below).

(HAS ANYBODY ELSE NOTICED THAT THIS IS THE SECOND PENIS-THEMED EPISODE DEPSITE THE FACT THAT THIS IS ONLY EPISODE 4? Disturbing.)

Grey is subjected to more sexual harassment from Dr. McDreamy yet the episode ends with a date between Grey and McDreamy.

Spare me.


Sandra Oh! (Dr. Cristina Yang) spends the episode kowtowing to a former nurse with pancreatic cancer in hopes of being asked to scrub in the Whipple she may need. However, the joke’s on Oh!: there are no plans to take the nurse to surgery because she has come to the hospital to die. Unfortunately, no one tells Sandra Oh! this fact, and she insists on attempting to resuscitate the soon-dead former nurse even though the woman is DNR.

Meredith’s mother doesn’t know Meredith or her father in pictures but does remember her former, now dead, scrub nurse fondly.

George suffers all episode as his roommates walk around in their underwear and send him out to buy tampons. This all seems unlikely to me, probably because most roommates I’ve had don’t even share their milk.

Lessons Learned

OK, this is going to be nerdy, but I can’t resist: I don’t doubt that somewhere, some surgeons take the easy way out to get out an hour earlier (even when it does the patient a disservice), but the writers picked on the wrong procedure to illustrate this point. The obsession with doing a “nerve-sparing” prostatectomy to keep the patient potent misses the main problem with prostatectomies: most of the people who get them, regardless of whether the nerves are spared, end up both impotent and incontinent, and this is very unfortunate given that many men with prostate cancer will never die of prostate cancer because the disease isn’t always that serious. Therefore, many men who get prostatectomies probably don't need them. A very smart colleague of mine wrote an editorial in JAMA last month, on the question: How do we improve outcomes among men with prostate cancer? And his conclusion was, basically: Do fewer prostatectomies and outcomes will be better. I don’t know the fictional patient’s Gleason score, but it’s possible that “Limp Harry’s” greatest crime was not initially refusing to spare the nerves but rather the fact that he did the surgery at all.

Don’t resuscitate someone who is DNR. You’d think, what with all the movies and shows overusing this point to illustrate doctors’ insensitivity to patients wishes and/or these same doctors' general inability to admit defeat, that this would be something that never happens in real life. In fact, I have witnessed people doing just this on several occasions. One time, when I was code leader as a resident, I threw an attending out of the room for refusing to stop CPR on his patient after I repeatedly told him that the patient was DNR/DNI. I hate to see it on screen, because I think it makes doctors look bad, but I also get why it actually happens: it’s hard to watch someone’s heart stop right in front of you (maybe somebody you care about and have known for years) and do nothing.

Um. Sexual harass a girl you like and she will go out with you? Horrendous, but it seems like that’s what happened with Grey and McDreamy. How could she resist the handsome, relentless attending? The power dynamic is disturbing. Again, it’s not that this doesn’t happen. I’ve seen it happen a lot. (Although it’s generally messier than this case-the attending is usually married with between 1 and 4 children. He is nearly always a man and the resident is usually a blond woman who is a minimum of 15 years younger than he is. Often, the affair is protracted and painfully public-the two end up getting caught making out in a car in the hospital parking garage in the middle of the day, for example) Maybe because of all this ridiculousness, I’m not a huge fan of watching this sort of relationship develop on TV. This plot line was one of the reasons I didn't want to watch this show to begin with.

Best Lines

Dr. Isobel "Izzie" Stevens: We're women! We have vaginas! Get used to it!” and also, as she rips off her shirt, “Breasts! How does anyone practice medicine with these things around?”

(I can’t help thinking to myself, “What is this, a Take Back the Night March?”)

Liz: What you got waiting for you at home? Boyfriend?
Cristina: Nope.
Liz: A girlfriend?
Cristina: Nope.
Liz: A pet? Family?
Cristina: A bed.

(Yeah, unfortunately, I totally get this.)

Episode 3: Winning a Battle, Losing the War

Notable plot points:

The sad truth is that I tried and failed to watch this miserable episode three times. A couple of times I fell asleep and once I got so angry that I left the room, went to another room with another TV, and turned on the movie “The Hangover.” Embarrassing, I know.

 
I have finally, officially, watched the entire episode completely. The complicated plot opens with a dreadful sequence of Meredith Grey’s new surgical intern roommates arguing and chasing each other around her mother’s house, but quickly transitions to a sequence involving the plot driver, Seattle’s annual “Dead Baby Bicycle Race.” DBBR is a real thing, although I doubt there are quite as many injuries as this episode would indicate.

Later, George is propositioned by a gay man who is dying of “liver cancer” (How very Roy Cohn of him, although it would seem that this character actually does have liver cancer given that a key plot point is his need for a transplant). Painfully, George must tell the man that he is not interested in the proposition for many reasons, one of which is the fact that he is not gay. When George confides his conundrum to his co-interns, all seem to be surprised by claim of heterosexuality.

The irony here, of course, is that the actor who plays George, T.R. Knight, was outed in 2006 when his costars, Dempsey and Washington, got into an on-set argument during which Washington told Dempsey, “I’m not your little f-----t, like TR Knight.” (That sort of behavior can only be called classy, and this was just the beginning of trouble on the Grey’s Anatomy set for Washington). As a result of the outing, Knight subsequently announced his orientation via People magazine.

As a side note, I was once propositioned by a patient, a camo-clad lesbian bearing tickets to an Ozzie Osbourne concert, and despite the fact that it did not precipitate a crisis about my sexual identity, I did find it extremely stressful to have to try to politely refuse the offer.I feel your pain, George, is all I'm saying.

Meanwhile, Dr. McDreamy really may be sexually harassing Dr. Meredith Grey. I mean, she definitely has a case if she chooses to bring it up with HR or a lawyer. He is her boss, but keeps asking her out, sometimes in inappropriate settings, like the locker room. Creepy.

All this is gravy, however, because the majority of the plot involves the interns scheming to harvest the organs of a brain-dead man, and this is the plot point that made me practically unable to watch the episode. The introduction to this patient is Izzie announcing “He could wake up because miracles happen!” and I immediately became afraid that this “brain-dead” patient would actually wake up, giving families of brain-injured patients everywhere false hope.

Thank goodness this was not the case, but it wasn’t much better given that the episode made the whole process of organ donation look something like “Weekend at Bernies.” The stuff they do to the poor, mostly-dead patient is only inches short of putting him on water skis.

 

Yep. This pretty much sums it up.

My other issue: The number of times the interns referred to the donation as “The Harvest” made me feel like I was watching M. Night Shyamalan at his worst: “The Village,” “The Happening”and now, "The Harvest."
 
Best lines
“I hate Chinese food!”

and

"I'm going to become a lesbian."

I don’t actually hate all Chinese food (how can a billion people be wrong?), but cheap Americanized Chinese take-out really is the worst. As for the lesbian comment, I usually am annoyed by straight women talking about how they wish they were lesbians (I can't take them seriously. Whatever.), but Sandra Oh! can say this all she wants and I'll never tire of hearing it.


Valuable Lessons I Learned
I once again realized that this show really is missing a key ingredient of intern life: pager servitude. We never see the Grey's interns get paged or return calls only to sit on hold. I can't even talk to my interns because they're always on the phone, or on hold, with someone. 

But then the surgeons canceled my patient's surgery but somehow never called me to tell me they had decided this (and she had been without food for 24 hours), and I realized that real surgeons do have something in common with the characters on this show. They don't use the phone nearly enough.

Episode 2: The First Cut Is the Deepest

Notable plot points:

Meredith Grey spends much of the episode carrying around a rapist’s severed penis in a cooler. The rapist’s victim has no family and is in critical condition and the only person who seems to care about the victim is Dr. Derek "McDreamy" Shepard. It’s clear that Dr. Grey fears that, in her isolation, she will one day be in the same position (as the victim, not the penis). Later, she happens to see a newborn in the nursery turn blue. Dr. Grey then attempts to tell the pediatric intern taking care of the baby that she suspects a congenital malformation of the infant’s heart. The pediatric intern, instead of being grateful that Grey caught a potentially fatal problem or grateful that she can now look very smart to her pediatric attending, inexplicably becomes angry and defensive. Grey then commits a serious medicine faux pas by going first to the infant's parents before going up the chain of command to the pediatric attending and cardiac surgery attending.  In the meantime, ex-model Izzie works in the suture pit where she learns the valuable lesson that undocumented people face discrimination. George finds out that everything he’d previously seen on TV regarding patient outcomes after codes was wrong. Cardiac surgeon Preston Burke is in competition with Dr. McDreamy, Derek Shepard for chief of surgery (at some unknown point in the future. The chief isn't going to retire anytime soon, but if these two yahoos are the only internal candidates for the position, I advise the hospital administration to consider conducting an external search.) In the end, Dr. Meredith Grey opts to reduce her isolation by allowing ex model Izzie and George to be her roommates in the home owned by her formerly-famous-surgeon-but-now-institutionalized-with-early-dementia mother.

My big news of the day:

1. Lawrence Dai sent me an email! Wow. I love that guy.

On Mon, Feb 14, 2011 at 10:06 PM, Lawrence Dai <lawrenceandjulieandjulia@gmail.com> wrote:
Brilliant. People compliment me all the time, but imitation really is the sincerest form of flattery. Best of luck and don't give up! (but if you feel like it, go ahead and give up)

Mad Respect,
Lawrence

2. My only use for Valentine's Day is that it helps me remember the day that my ex wife and I broke up and will now help me remember the week that more recent Ex broke up with me. 

Letter to future ex-girlfriends: please break up with me on Valentine's Day because I've always thought it was a dumb holiday but it's been officially ruined for me since 2005.

On second thought, I should just stick to my vow to never date again. The last thing I need is more ex-girlfriends. Perhaps instead, I'll spend my next 30 Valentine's Days like I spent this one; sitting on the couch, eating brownies, and watching "The Biggest Loser" with my married straight friends.

3. I returned to the wards today and, for one hour, while the interns were in a teaching session, I held their pagers. Seven minutes into the hour, I literally wanted to throw the pagers against the wall. One of my interns was paged every three minutes. It really brings home this message from Episode 2 of Grey's: "There’s a wall with the attending and residents over there being surgeons and the interns over here."  Yes, interns have crappy lives and residents and attendings don't remember how much better their lives are than they used to be.

4. It is with a great deal of shame that I admit that Meredith Grey and I had a common experience today: After I spent a good portion of the day trying to find a decision-maker for a patient with no family, I drove home thinking about the fact that I will likely one day be in critical condition and there will be no one to make decisions for me. I called one of my best friends, a single-mother doctor to let her know I may designate her to take on this job. Then I made the mistake of imagining the conversation the ICU team is going to have about me: "Well, she has designated some friend who lives in another state as a decision-maker. I don't think it's a partner or anything. My, what a sad situation." 

Note to anyone making medical decisions for me: When in doubt, withdraw care.

Pilot

The Show  (from Wikipedia):

 

The series focuses on a group of surgical interns, residents, and the various physicians who serve as their mentors in their professional and personal lives. The five characters who are first introduced as interns are Meredith Grey (Ellen Pompeo), Alex Karev (Justin Chambers), George O'Malley (T. R. Knight), Izzie Stevens (Katherine Heigl) and Cristina Yang (Sandra Oh). They progress to residency after their first year in the surgical program. Their first resident is the stereotypically tough surgical resident (in the tradition of ER's Dr. Benton), Miranda Bailey (Chandra Wilson). The surgical program is run by Chief of Surgery Richard Webber (James Pickens, Jr.) who has a pre-existing personal relationship with Meredith, having had an affair with her mother when Meredith was a child. In Webber's employ are attending physicians Derek Shepherd (Patrick Dempsey) and Preston Burke (Isaiah Washington), who specialize in neurosurgery and cardiothoracic surgery respectively.

The Contender:

I am a lesbian doctor who was recently dumped by the woman that I once thought I was going to marry. I can’t say it was a total shock, because she had been saying things for weeks (months?) like “We might not see each other for awhile,” so I had many sleepless nights to think about what I would do if she dumped me for real. And for some reason, my late-night, semi-crazy conclusion was that if she dumped me, I was going to watch Grey’s Anatomy. All of it.

I didn’t come to this decision because I’m a fan of the show. I’ve maybe seen part of one episode once, so the idea did seem a little crazy. But then, as I walked out of her house for the last time, I stopped, I turned back to her and said, through my tears, “I’m going home and I’m going to watch every episode of Grey’s Anatomy. And I promise you, after I do, I will feel better.”

And I’m somebody who does what she says she is going to do.

Here, then, is the list of reasons (that I came up with in the middle of the night) that made me decide that I’m going to watch every episode of Grey’s Anatomy ever made:

1. Drama: One of the reasons I haven’t been able to watch the show is that before now, I couldn’t tolerate overwrought drama. But now, drama may be exactly what I need. I want to watch 100 episodes about medicine and relationships and I want to cry at the end of every single episode. And after that, I bet I’ll feel better. And by better, I may mean worse.

2. Story lines that parallel my life: I really haven’t ever seen the show, but I want kids and Ex did not. And that’s one of the reasons we broke up. Supposedly this is relevant to the show at some point.

3. Music: Mark Lawson of The Guardian has credited Grey's Anatomy with popularizing the "songtage", or musical montage segments. This would have the potential to be lame if the music of the show were not so good. And sad. To quote Starlee Kine, “There’s something so satisfying about listening to sad songs…Sad songs don’t judge you. In fact, they understand you. A break up song won’t ever suggest that you start online dating or that you’re better off without her. They tell you that you’re worse without her, which is exactly what you want to hear because it’s how you feel.” Yeah. That.

4. I’m not in training anymore: I’m an attending, and all of my frustration with the inconsistencies and inaccuracies the show presents about the experience of medical training are lessened.

5. In the tradition of the Julie/Julia/Lawrence blog, it’s good to write about something that anyone with a Netflix account can relate to.

6. As I think of more reasons, I will post them.

365 days, approximately 100 hours of Grey's Anatomy. (Wow, that doesn't even sound impressive.)

One doctor, her Netflix account, and a blog on which she hopes to remain totally anonymous forever. She is not even telling her friends that she is doing this.

The Pilot:

We are introduced to the interns, all whom seem to start on a shift that lasts 48 hours long. During the course of their first call day, some will be called to operate with no apparent experience (remind me not to get appendicitis in Seattle in July) and others will fear that this residency-thing is not what they bargained for.

I swear I will resist harping on all of the inconsistencies and total inaccuracies this pilot demonstrates when it comes to actually being a resident (quick review of my notes: 48 hour shifts are illegal, what locker room?, interns are not nurses, have these people never heard of a neurology consult service, how do they have time for all this angst? etc).

My favorite line, the truest line of the pilot was this:  “Today you are the doctors.” Last time I was on service I said something very similar to my interns in an attempt to get them to take some responsibility for their patients (and I think they also hated me for it).

My other favorite lines? “Don’t bother sucking up. I already hate you.”

And, “We’re going to survive this right?”

This answer to this last line is more complicated than residents might wish for on their first day of internship. Yes, you will survive, but your life and your view of the world will be changed forever, and not necessarily for the better. You will leave wiser but also less optimistic, less trusting, and, depending on your abilty to juggle your schedule and your time with your family and friends, possibly less loved.

OK, that's enough of that. They're actors, not residents. And they make it through season 7, at least. Remind me not to get philosophical ever again.