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