Episode 12: Make me lose control

I return after a week away at “fitness camp,” during which time I really thought I would be able to watch an episode or two and write about it. Fitness camp was great, really great, but it left no time for watching DVDs or writing. The schedule was a 6 AM stretch class followed by breakfast and two hours of hiking in the morning, followed by another class, usually on the cardio machines, followed lunch and three hours of classes (e.g., cardio circuit, kickboxing, swimming, etc) in the afternoon. Dinner was at five, after which there was often a lecture. If I wasn’t in bed by eight thirty, I was hurting the next day.

Add to this that I had to decompress after dinner with my friend Tracy. Our after-dinner conversations weren’t that deep, but they did take away from my blogging time. Mostly, we reviewed the funniest events of the day. For example, on Wednesday, an older woman who was sitting next to me in the hot tub put her arm around my shoulder and said, “You’re such a darling that I want to give you a tip. You really should consider getting your asshole waxed because I just did and it felt amazing. I know you’ll really love the way it feels.” Of note, I was mortified and did not proceed with this suggestion.

Waxing recommendations aside, I feel good about the social connections I made with people there, and as the week progressed, I actually noticed that my exercise tolerance improved a lot. In our last cardio circuit class, I ran at 7.5 on the treadmill for several of the rotations. It felt great to have made such progress during the week.

I have now returned home to pages and pages of unanswered work emails, but I am making my commitment to Grey’s my first priority.

This episode is one of the best yet. The writing is snappy and concise. The plot is clear and well-thought out. The first scene opens with our two favorite interns, Drs. Grey and Yang, out for a jog. They’re clearly already out of shape and struggling with their run. This is not all that surprising, seeing as they’ve been working what appears to be a “pre-work hours rules” schedule (maybe 120 hours a week?) and they seem to spend all their free time having sex with attendings, hosting wild parties, and, occasionally, caring for a demented parent. They are lamenting their situation in the first scene when they berate each other with this exchange:

“Slutty mistress.”

“Pregnant whore”

“Sleeping with our bosses was a great idea.”

The episode centers on several plot lines: Izzie and Alex are becoming friends, consistent with the “douche with a heart of gold theme” the writers seem to be forcing on Alex. Seeing their connection from afar, George announces:

“Make the lambs stop screaming.”

                             Douche with a heart of gold.

The McDreamies (Derek and Addison) are still not getting along:

McDreamy to Chief: “Maybe you should have thought of that before you gave chief to Burke and invited Satan to Seattle.”

Chief: “Satan?”

Addison: “Good morning.”

McDreamy: “Satan speaks.”

Addison: “Actually, I prefer to be called ruler of all that is evil. But I will answer to Satan.”

                       Is Satan a redhead? McDreamy seems to think so.

Despite this, they are forced to work together on a case in which a newborn who was born premature and addicted to narcotics also happens to have a spinal tumor. Derek doesn’t want to operate, but Addison is trying to convince him it’s the right thing to do:

(arguing over neonate that may need spinal surgery)

Addison: “Derek, you’re not God.”

McDreamy: “Excuse me?

Addison: “I’m sorry, honey, but you’re not…you don’t get to decide…”

McDreamy: “Did you just call me honey? Don’t call me honey.”

Addison: “Fine, you’re not God, Dr. Shepard, but you have a responsibility…”

McDreamy: “Don’t talk to me about responsibility.”

Addison: “You took an oath, Derek.”

McDreamy: “Don’t you dare talk to me about oaths.”

Addison: “Derek, I messed up. People mess up.”

McDreamy: “You slept with my best friend on my favorite sheets.”

Addison: “You hate those sheets! Derek please, she has nobody. She needs someone to fight for her.”

McDreamy: “She’s too far gone. Let her rest in peace.”

Addison: “Fine, walk away. It’s what you do best.”

The big news, though, is 1.) Cristina Yang’s pregnancy is ectopic, and she needs urgent surgery to save her life, which means that she loses a fallopian tube and, oh, yeah, the entire hospital knows that she was pregnant; and 2.) Meredith’s mother is finally admitted to Seattle Grace. It was clearly just a matter of time before this happened-and it’s pretty realistic, actually, seeing as demented nursing home residents tend to be frequent flyers. She’s a little bit too healthy-looking for the diverticulitis and the liver mass they find, but other than that, it could totally happen.

Bailey, as promised, is emerging as the moral center of the show, which is made clear when she keeps Meredith from barging in on Cristina’s surgery:

                                               

Meredith: “I’m coming in.”

Bailey: “No, you’re not. She’s lying on the operating table. Naked. Exposed. She’s not a doctor. She’s not your friend. She’s a patient, and she deserves to have all the privacy I can give her.”

Meredith: “You have to let me in there.”

Bailey: “You can try, but I’ll have to take you down.”

Meredith: “In this moment, I hate you.”

Bailey: “I can take it.”

Oh, later in the episode and right on cue, the McDreamies appear to be reconciling. He called her Satan in the morning, but they were kissing by the 7 PM nursing shift change.

   Now this is actually interesting. How is it that I'm weirdly rooting for Satan?

Through it all, Meredith holds it together, saying repeatedly, “I’m fine. Just fine.”

At the end of the episode, after a day of “I’m fines” to everyone who will listen, Meredith is finally crying. She says to McDreamy: “I’m just exhausted. My mother is exhausting. What happened to Cristina is exhausting. And hating you is the most exhausting. I don’t want to do it anymore.”

And so, my friends, I have learned my first real relationship lesson from Grey’s. After weeks of putting myself through the wringer, I'm exhausted and I don’t want to do it anymore. And I’m not going to.

Thank you, fitness camp. Thank you, Grey’s Anatomy.

BTW: not cured yet. But better. Definitely better. 

Episode 11: Enough is Enough

I get the feeling this episode was written by a free-lance writer, the sort of person who doesn't really know the characters but can write "filler" episodes when needed. The opening scene is the best scene in the television-hour (the televion hour is 42 minutes; 8 minutes shorter than a therapy session and hundreds of dollars cheaper) and features Meredith and Cristina wallowing in pity. Meredith is drunk and lying on the bathroom floor. Cristina is sitting in an empty bathtub, fully clothed. As Meredith slowly sinks into oblivion, her head in the toilet, the narrator announces the theme of this episode: that even when given the option to “say when,” to declare that enough is enough, most of us don’t because we mistakenly think that more is always better. 

It's not that the theme is untrue (why, Ex frequently said to me as I was piling our dinner plates with food or overpacking a suitcase for a weekend trip, "Remember that more is just more."). My issue is that the theme doesn't make total sense with the majority of story lines in this episode. Not that I care.

                              "Judy" dolls.

The one "patient" in the episode who embodies the theme is a man who ate a stomach full of Barbie heads (well, they were called “Judy doll heads” because Barbie is trademarked, but we all know what they meant).

Grey: "Why 10 doll heads?"

Man: "Because 11 would have been too many."

I’ve seen several patients like this during my career, people who suffer from a disorder called pica. (Not to be confused with Pica’s restaurant outside of Philadelphia. It looks to be as good as its name.) Pica can be caused by iron deficiency, but can also be due to psychiatric problems. People with the psychiatric type of pica will eat just about anything: entire 12 packs of AA batteries, fistfuls of ibuprofen, small glass figurines, lumps of coal, car keys, and yes, even doll heads; the result of these ingestions is abdominal pain and bowel obstructions that lead to emergency room visits, hospital admissions, frequent radiographic imaging, and medical procedures like endoscopies and surgeries to remove these items. The bottom line is that people with this sort of pica can be infuriating, in the worst cases requiring long-term psychiatric hospitalization because they pose such a danger to themselves. I remember momentarily leaving the bedside of a woman with pica only to find she had swallowed the latex gloves I’d accidentally left on her table. I looked down, realized my mistake, and calmly turned to the intern and said, “Will you please call GI to let them know that we need to revise our earlier consult request to now read ‘patient has ingested 4 batteries, a fistful of ibuprofen, a Hummel figurine, and two latex gloves?’”

(The scary, and funny, thing is that there is a unique brand of pica, described in the New England Journal as “Tomatophagia,” that I actually suffer from. Don’t believe me? Check out this excerpt from an entry I wrote on a previous blog:

“It started in late July. I was walking through Whole Foods, minding my own business, looking to purchase a bottle of $30 truffle oil, $10 marinara sauce, or maybe fifty dollars of prepared food. That's when I saw them. They were beautiful, round, luscious, soft, colorful heirloom tomatoes. I picked one up touched it to my cheek, smelled it, and then put it back (hoping no one would see that I had just exposed it to so much bacterial flora). I knew I shouldn't buy one. They were $5.99 a pound.

"But," I thought, "What's a few dollars in the grand scheme of things?" So I gently set one in my basket, and then bought it (at the checkout, the cashier held it up and said, "You know that this is a seven dollar tomato, right?" After I nodded, she mumbled, under her breath, "Mm-mm. crazy.").

Unfortunately, it took only one taste of that magical fruit to create an addiction I could not keep a handle on. It ruled me. In no time, I was eating 14 dollars worth of tomatoes a day. And that's when I knew that I must admit it: I am a tomatoholic. I admit that I powerless over heirloom tomatoes.”

Geez. In addition to my other chronic conditions, I now have tomatophagia. Well, to be clear, I’m not iron deficient, so maybe I don’t actually meet criteria.)

But back to Greys. After the doll heads are removed (surgically, of course) Grey confronts the pica patient:

Grey: “How do you feel?”
Pica: “Empty.”

Grey: “Yeah, I’ve been feeling a little bit of that myself lately."

Of course, Grey’s emptiness is not caused by a lack of doll heads in her GI tract: she’s empty because she spent the previous night puking her guts out and also because she and McDreamy broke up when she discovered he was married. I hope we get back to that plot line because this episode was WAY less interesting without it.

The rest of the plot centers on an alcoholic wife beater on the liver transplant list who caused an accident because of his road rage. Somehow, the alcoholic’s only hope for survival is that his son agrees to donate a piece of his liver to his abusive father.

Alex (Frat Boy), after his first season as a one-dimensional character (and that dimension would be “douchebag:” e.g., he was “patient zero” in the hospital-wide syphilis outbreak, he plastered the hospital with posters of Izzie’s underwear model stint, and he said those mean things to the now-dead lady with the 60-pound tumor), is getting a second season makeover. Unfortunately, these writers have inadvertently turned him into the sensitive naked man, the sort of person who, in the last episode, spent hours at the bedside of the bartender with the “standstill operation,” and this episode is the only physician to identify a Barbie head on an Xray. Later, he convinces a battered women into being honest about her situation and connects with the son of the alcoholic wifebeater. This turnaround is not believable (people don’t change this much this quickly) and because my brain can’t make sense of it, I repeatedly looked at him on the screen and said, out loud: “You’re a great guy and all that but I’m still feeling really creeped out by the fact that you’re naked.”

George revives the “Weekend at Bernies” theme when he decides that a woman who is supposed to be an organ donor is actually alive because she is exhibiting a behavior known as “decerebrate posturing.” True, she’s not technically brain dead but she’s damn close, and McDreamy’s claim that “she’s still got a good shot at recovery” is both misleading and disturbing. Recovery in a patient this far gone has only very, very rarely been described in the medical literature.

Last points:

The code at the beginning of this episode may rank as the worst CPR ever seen on television. And that includes the fifteen or so “precordial thumps” in the first season of Lost. Good job, George. Again, I wonder what happened to the show's medical consultant (p.s. you also described asystole as “pulseless Vtach” and then shocked an asystolic patient.)

 

                              worst CPR in the history of television.

The poor CPR effort would seemingly go against the very lesson Bailey was trying to teach you, George: 

Q: “Why do we hump on every dead person that comes through the door?”

A: “So we can tell their families that we did everything we could possibly do.” 

Cristina’s best line: “The worst part is not that he broke up with me. It’s how he broke up with me. And what’s worse than that is that I care.”

On my end, I'm one day from leaving for "fitness camp" my spa-exercise vacation. Wish me luck, as I will definitely need it. I'm excited to blog about my time there, although I fear my arms will be so sore I won't be able to hold them up to type.

Episode 10: Raindrops Keep Fallin' on My Head.

Raindrops. You can say that again. I’m one season in, and it’s been on my mind that I should quit writing this blog. I’m writing whiny post after whiny post about a show that I hate, all for a paltry two hits a day. But today was a turning point. I’m not quitting anytime soon. I am rapidly moving through the Kubler-Ross stages of grief (more on this below), and it’s kind of fun to be publicly documenting it. This episode, the first of the second season, was far more interesting than any of the first season duds.

We found out at the end of last season that McDreamy is married. He is married to, and separated from, a smokin' redhead named Addison Adrienne Forbes Montgomery Shepherd. She is a neonatal surgeon, and a super-hotshot at that. While she and McDreamy were still together and living together in New York, she had an affair with McDreamy’s best friend, prompting McDreamy to leave her and move to Seattle. Addison has now arrived to Seattle, ostensibly for work, but we all know where this is going. On first seeing McDreamy with Meredith, she says of Meredith, “She seems sweet, which is what you were going for, right? The anti-Addison?”

                              McDreamy’s Ex. Attractive, mean, adulterous redhead. 

 
I actually have some experience with attractive but mean adulterous redheads, and I, too, hope for someone sweet on the next go-around. So I get that he went for sweet. Otherwise, though, Meredith is whiny, anorexic, boring, and a surgical intern, and I can’t imagine he’ll overlook these drawbacks for long. Not while he has the hot Addison trying to win back his affections. (Note to future self: be smarter than McDreamy is about to be: If she shows back up, don’t take her back.)

The real star of this episode is a type of brain surgery called a “standstill operation.” I’d never heard of this before, and when I tried to google “standstill” the only hits I got were Grey’s Anatomy episodes. Still, this type of surgery is a legitimate medical entity; it’s a brain surgery that can only be performed while the patient is cooled into hypothermia and the heart is stopped. It seems like it was more popular in the 90s than it is now, but it isn’t totally unheard of. Burke and McDreamy do the operation together, and, for once, Burke’s patient lives.

Cristina hasn’t told Burke that she’s pregnant, and before she gets a chance to, he breaks up with her. We’re meant to think that Burke has finally realized that dating an intern is a mistake, but some part of me thinks that the minute his surgical outcomes improve (they have been abysmal until now), he no longer needs sex with an intern to fill the void. Cristina ends the episode bereft, drinking in a bar with Meredith.

My favorite moment of the episode is the last scene, when Cristina tells Meredith that she has made her the emergency contact at the abortion clinic.

Cristine: “I needed to designate an emergency contact. That’s why I told you I’m pregnant. I put you down as my emergency contact. You’re my person.”

(Grey leans in and puts her head on Cristina’s shoulder.)

Christine: “You realize this constitutes hugging?”

Grey: “Shut up. I’m your person.”

I have heard people say before that the most interesting relationships on this show are the friendships, and this was one of the first moments on this show where I felt any deeper interest in any of these characters. Maybe it was the cute chatter, but maybe it’s because friendship is a theme that certainly resonates with me right now-I have amazing friends who have been there for me in a major way, and I’m so lucky to have the support I’ve had. Sorry, friends, that I’ve been so bitchy and negative these last weeks. And thank you, thank you, thank you for being my people in spite my flaws.

Best lines:

Bailey: “Who’s Dr. McDreamy? I’m doctor McDreamy. I’m tall, handsome, I like to lean against things and ponder the difficulties of dating beautiful women. Come on, I’m trying to be a surgeon here.”

Burke: “I noticed we’re both off tonight. I made reservations. I have a favorite restaurant.

Yang: “None of those were questions.”

Chief: “I just had brain surgery. I’m surrounded by fruit baskets.”

Alex: “Surgery is the only specialty where we don’t waste time getting to know the patients.”

Best line I’ve heard this week, actually from the movie Date Night: “You think I want to spend the rest of my life stealing wheelchairs for a living?”

ps: Those Kubler-Ross stages of grief? The ones we all learned for Psych 101 and in medical school? You know, the ones that were a theme of every single episode of "Touched by an Angel?" Denial. Anger. Bargaining. Depression. Acceptance. They ring so true and I do feel like I'm moving swiftly towards acceptance here, which I was feeling really good about. Well, I was feeling pretty good until I reread an article from one of last year's New Yorkers: "The trouble is that [Kubler-Ross's theory] turns out largely to be a fiction, based more on anecdotal observation than empirical evidence" and oh, also, according to Slate, Kubler-Ross "went round the bend," becoming a believer in reincarnation and engaging in all sorts of odd behavior. Finally, she suffered a debilitating stroke, and was left to die alone. This is from one of her last interviews: '“I always leave the television on,” she says. “That way something is always moving.” An English muffin hardens next to her on a plate. She says that she got in the habit of saving food in case she is hungry later in the day. She seems as hauntingly alone as the patients she interviewed some thirty years earlier.'

Now I'm back to freaking out again.

Who's Zoomin' Who?

Well, this is a landmark day, because finishing this episode means I am officially through Season 1! Only 6 more seasons to go until I recover from this breakup completely. Unfortunately for me, the rest of the seasons have more like 25 episodes. Season 1 has 9 episodes. Still, it’s quite an accomplishment to be through one insufferable nightmare of season, punctuated by intern-attending hookups, outlandish clinical scenarios, and, in this episode, secrets.

The secret rundown: Grey has kept it a secret from McDreamy that her mother has dementia and is in a nursing home. McDreamy is getting calls on his phone that he never answers. Cristina is pregnant and considering an abortion, not that she’s told Burke. George has an itchy rash in a private area, which Frat Boy diagnoses as “syphilis” even though the first sign of syphilis is a non-itchy, single, firm, painless chancre, not an itchy rash. (I would call this the first real medical mistake on the show-they’ve stretched the truth before, but this is blatantly incorrect). And the biggest secret of the show (well, besides the fact that the syphilis outbreak turns out to be hospital-wide, and anyone who wants to be treated gets to stand in the “syphilis line.” If this scenario were true, this would be New England Journal material.)? McDreamy is married. I should have known, given all the phone calls he doesn’t answer and the fact that most surgical attendings are married, but it never crossed my mind, somehow.

There are also two cases of doctors treating each other without records, billing, or accountability. Frat boy treats George for syphilis and McDreamy somehow performs brain surgery on the chief without billing anyone for the OR time. This is, by far, the most unbelievable thing that has happened on this show: if the Chief were a real hospital administrator, he would be far more concerned about the lost billing for 8 hours of brain surgery than he would be about his colleagues finding out that he has a brain tumor (there's a public "syphilis line," but there's shame in having a brain tumor? I’m so confused.). 

 

Syphilis outbreak at Seattle Grace. That's a reportable illness you're treating there, Frat Boy.

In the end, the chief’s brain tumor is magically gone and he has no apparent neurological deficits, and, in fact, moments after his surgery he is well enough to notice that Meredith and McDreamy are involved, a fact he blames on Meredith even though McDreamy is the attending. Everybody else is so busy stressing out about their secrets, having sex, and getting treated for STDs that nobody bothers to write the New England Journal article describing one of the first hospital-based syphilis outbreaks in modern history (if it even is syphilis, since they’re all itchy, which, I must emphasize, doesn’t make any sense. I bet they all actually have crabs, described best by the guy who once came to me asking “You got anything for crotch critters?”)

       

Watching all these characters reveal their secrets has made me want to reveal that I have some secrets, too. First, I resisted my friends’ demands that I go on Match.com. I resisted for exactly 24 hours. I then created a profile and went online. As predicted, it was a total nightmare. In the end, I laughed myself to sleep thinking: “Match.com is 10,000 spoons when all you need is a knife." I've been waiting for 20 years to use that line, mainly because it's not ironic and it doesn't make a lot of sense, but in this case, it just fits. I need that knife to slit my own throat, because I'd honestly prefer that to internet dating. Instead, I have 10,000 people I don't want to date right at my fingertips.

Second, I have decided to spend my vacation at a “fitness camp,” one of those places where you work out 6 hours a day. On some level, unless I am planning to eventually write a book along the lines of “Eat Pray Love” (Given this is fitness camp, I guess it would be called “Nibble, Beg for Mercy from Ruthless Trainers, and Hope to like the people you meet”), this is embarrassing. On another level, I should be proud of myself for doing something that is so out of my comfort zone. I have taken to half-lying about it, calling it a “spa trip.” Yeah, it’s a spa. A spa where they make you exercise 6 hours a day.

 Best lines of the Season 1 Finale!

 “I never talk about my penis with other men.”

“What’s in my closet is none of your business.”

“Why are you in this line?” 

“It’s a syphilis line.”

“When would I have time to go out and get syphilis?”

“He had a blood condition known as HEMATOMOCHROSIS”

(yes, Sandra ‘medical malaprop’ Oh! mispronounced hemachromatosis.)

On to Season 2.....

Episode 8: Save Me.

Yes, please save me. Ex dropped her dog off with me today so she could go on vacation for two weeks. She’s off to (DO WHO KNOWS WHAT) with (IF I WERE TORTURING MYSELF I WOULD TRY TO GUESS WHO). Just to add to my self-esteem hit parade, last night, in my women’s recreational soccer league, my team, (a motley crew consisting of 35-40 year-olds, half of them moms) played a championship-winning varsity college team. Needless to say, they demolished us. We looked like amateurs. Losers. After the game, my teammate was upset, and turned to me and said, “I’m just mad that I was never as good as they are right now.”

Well, true. Neither was I. Once upon a time, I was pretty good, but I was never a super hotshot college student who attends an elite liberal arts college and plays varsity soccer. I was more a state-school, club-soccer-kind of girl. The team we played last night was full of winners in the most annoying sense of the word, and we’re, well, 40ish with desk jobs and a few extra pounds.  

Still, as much as the mortgage and the job and the few extra pounds are weighing me down, I’m not sure I’d trade them to be in the shoes of a college student again. I never cried at weddings until I was over 30 and divorced-now I cry because yes, it’s very sweet, but also because I secretly want to pull the newlyweds aside and say, “You have no idea the pain you’re in for with this little venture of yours, so good luck.”

I guess what I’m trying to say to the winners who clobbered us last night: You’re ridin’ high now kids, but just you wait until life is ridin’ you. Or, alternatively, wait until I’m your attending and you’re my third year medical students (that’s four years from now, juniors, not that I’m counting), because I’ll probably make you cry. See, I am embracing my new identity as a hypercritical attending. Instead of feeling guilty that I made that medical student cry, I’m going to be slightly sadistically happy that I could steal the last bits of her youth and idealism right out from under her. And no, I won’t write you a recommendation for residency unless you’ve actually done a good job. And I have high standards.

But back to Grey’s. This episode seems to be consistent with my current life situation: it opens with “You know how when you were a little kid and you believed in fairy tales? That fantasy of what your life would be? White dress, prince charming…you had complete and utter faith. Eventually you grow up, open your eyes and the fairy tale disappears.” Yes. That’s exactly what I’m saying here. Weird.

Then it says, “Almost everyone still has that smallest bit of hope, of faith that one day, they’ll open their eyes, and it will all come true.” Uh, not so much. I just suffered through a dinner where all my friends tried to convince me to go on Match.com. Nightmare. Don’t they get it? Match.com works for normal people. However, I am not normal people. The freaks I met during my brief stint on Match scarred me for life. Sometimes, me still cry alone at night over it. In addition to the freak-magnet issue, the number of people I could possibly date in the world is so small that there is no point in looking, and there’s particularly no point in looking for love at epicenter of painful rejection in the modern world, otherwise known as Match.com. I swore I would never put myself through that again. And I won’t.

The plot of this episode again verges on the ridiculous. There's an orthodox Jew who needs a porcine valve (of course) and there's also a psychic who may really be a psychic or may be having seizures that make him think he is a psychic. And Cristina is getting an abortion. Maybe. Only the psychic knows for sure. In the meantime, she has to convince a pregnant woman with breast cancer to get an abortion and start chemo (of course she does). And George is having troubling with intubations. In an early scene, he intubates a patient’s esophagus.

It’s not such a big deal to intubate an esophagus. “Don’t you know an esophagus from a trachea?” Demands Frat Boy. Hey, smart aleck, it’s actually hard to tell the difference. Esophageal intubation happens all the time. It’s easy to fix and in the meantime, you bag the patient.

Best quotes of the episode, the Cristina Yang/Sandra Oh! version:

1. Cristina to Neuro resident: “Did you go to medical school?”

 “I did. Unlike the correspondence school you attended.”

“Yeah? That’d be Stanford? Stanford correspondence?”

 

2. "Why does every thing in a hospital smell like a hospital?" 

(So true. Never take the lotion home. It's free, but it's not worth smelling like a hospital.)

3. Cancer patient to Cristina: "You know you have quite the bedside manner, right?"

4. Psychic to Cristina "God, you're hot...in a Mrs. Livingston kind of way." 

The episode ends with McDreamy showing Grey his trailer. They grab hands and walk in together. My take on this: They have no idea the pain they’re in for with this little venture of theirs. 

Episode 7: The Self-Destruct Button

Number of times I fell asleep while watching this episode: 4. Now, this could be just that my life has been really crazy and I have been super-tired, but it might also be that this show is honestly terrible. After falling asleep the third time, I woke with a start (when the credits started to roll) and said to myself, “Why couldn’t I have chosen a GOOD show to blog about? I could have watched retro episodes of The West Wing or ER, the show that was on while I was in training (yes, I am old. I admit it.). In other words, I’m experiencing the kind of regret that Lawrence Dai must have felt after watching Julie and Julia for the 17^th time. Julie, like Meredith Grey, is really really whiny, the kind of person that, in time, one starts to hate.

This snoozer of an episode opens with an alarm going off, indicating that it’s 5:20. We find Meredith and McDreamy struggling to get out of bed after a very late night (of course, 5:20 is very late for a surgical intern. 4:20 or 3:20 would be more realistic; Ask Dr. McAwesome, who told me today that she rode her bike to work at 3:30 AM during a surgical rotation). Despite the unbelievably late hour, The Grey-McDreamys’ lack of interest in sleep may be somewhat realistic. As I have said before, residency affects a person in odd ways. Suddenly, an exhausted intern has thoughts like, “I haven’t slept in 30 hours, but I feel fine. I should drive two hours to the beach to hang out with my friends for 12 hours before I have to be at work again.” (It seemed like a good idea at the time.)

Key points of this episode:

1. Grey is taking care of a thin college girl who got a gastric bypass in Mexico to please her even thinner mother; Frat Boy tends to a young guy with a GSW who chooses to get shot repeatedly for the purpose of body art; and Cristina Yang can't stop puking from a "flu." None of these story lines are all that interesting: it's not news that rich, too-thin white people try to force their kids to be the same and their kids try to comply in any way possible; I don't believe anybody gets shot on purpose, and this is the second episode with this "flu," so it's starting to seem fishy, but we're given little information until the end. More interesting is that George, who is taking care of a young child who needs a hemispherectomy, intervenes when he believes the anesthesiologist has been drinking. He’s right, but he gets thrown out of the OR, anyway (by McDreamy). Only later, when the anesthesiologist falls asleep during surgery, does McDreamy realize he’s made a mistake in criticizing George rather than investigating the problem. In real life, if you’re a surgeon and anyone accuses your anesthesiologist of improper behavior, I’d recommend you believe the accuser until proven otherwise. Sorry, anesthesiologists-I don’t trust anybody with a pocket full of fentanyl. 

 

 2. In line with all the other quality problems at Seattle Grace, Bailey asks Izzie to do a bronchoscopy by herself despite the fact that she has never even attempted one under the supervision of the attending. Apparently, this is the way things are in the Seattle Grace “see one, do one, teach one” residency program. SODOTO is an old-fashioned ethic that no longer exists, except in the case of some minor procedures with very limited likelihood of complications. Where I work, our residents practice procedures on mannequins for months before attempting anything on a real person. They are always supervised, keep a record the numbers of procedures they do, and don’t do any procedures alone until they are “signed off” by an attending (i.e., they’ve done a sufficient number of procedures successfully). There were many reasons SODOTO ended (including diminishing tolerance by hospitals and the public for poor quality care), but one of the first reasons this started to change was because of lawsuits brought by former residents, like this one in 1998:

“A jury has ordered the University to pay $12.2 million to a former who contracted HIV from a needle prick ten years ago. The plaintiff, identified only as "Dr. Jane Doe," said that her superiors had failed to train her properly.

Dr. Doe had been a resident for seven weeks when her supervisor asked her to insert a catheter into an AIDS patient's artery in August 1988. When blood spewed from the catheter after she removed the needle, Doe put her thumb over the opening to stop the bleeding, sticking herself with the nearby needle in the process. Her attorneys argued that she had not been told how to minimize the risk of the procedure, which she had performed only once before. Hospital attorneys maintained that Doe had received excellent training and should have taken better precautions. They also said that the hospital, not the University, was responsible for her training.

"Hopefully this will send a message loud and clear that you have to train people," said Doe after the jury announced its award.

My personal worst case of SODOTO occurred while I was trying to put in an IV as a third year medical student during my second rotation. After I saw a nurse put in an IV once, I was expected to “do one” without supervision on the next patient who came in. Unfortunately, I didn’t take off the tourniquet at the right time and the patient bled all over the floor. I called for help, but no one came to help me, so I started swearing (loudly, every word in the book and right in front of the patient) while I attempted to stop the bleeding. The patient complained about my “unprofessional behavior” and I got a “talking to” from the resident. For the rest of the rotation, all of the residents and attendings thought I was some kind of a**hole. The main lesson I took from this, besides that SODOTO is a ridiculous way to teach anything, is that some days, being a medical student is WAY worse than being an actual doctor.

3. Burke's outcomes continue to be abysmal. Does he have any patients that live?

Best lines:

Grey to Bailey:

“She’s febrile” (pronounced to rhyme with tendril rather than feb-rile)

McDreamy to drunk anesthesiologist:

“Get out of here and get it together.”

(My thought: This is how we deal with impaired physicians? This hospital is in the dark ages)

Grey to gastric bypass girl:

“Life is not supposed to be this hard.”

(My thought: but it often is.)

“Why do I keep hitting myself with a hammer? Because it feels so good when I stop.”

(I’m keenly aware that this is sort of the way I live).

Closing thoughts? The picture below is supposed to be but is not pus. It looks like whipped cream. I have been sprayed with pus (testicular abscess opened by urologist with me assisting in the ED, total yikes) and it was not nearly this pleasant:

Oh! Big revelation: Cristina Yang's flu? She's pregnant. This might actually be getting interesting….