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.”