Sunday, April 10, 2005

Back in town just in time to catch Grey's Anatomy

I spent Saturday and the better part of today in Chicago for my friend's bachelor party. I learned two things: 1) Having a Super Bowl ring, as my friend's soon-to-be brother-in-law wears on his left index finger, opens more doors than you can imagine. People with Super Bowl rings do not wait in line. I must set about procuring a Super Bowl ring for myself as soon as humanly possible -- hopefully the gym is still open at this hour, and I can pound out a couple of sets of bench press. 2) Strip clubs make my skin crawl. When I have a bachelor party of my own, I think I'll insist upon all of us spending the day opening doors, pulling out chairs, throwing our coats over puddles, and otherwise engaging in chivalric behaviors as symbolic atonement for all the mischief and debauchery of bachelor parties throughout human history.

Anyways, the party overall was a lot of fun, and I got to see and experience my friend become increasingly bellicose as the night wore on, culminating with him sucker-punching me -- unprovoked -- in the right kidney. But hey, at least I have two of them, right?

So I returned home just in time to run a few miles, eat, and sit down for a full episode of Grey's Anatomy. As I've previously mentioned, I have voluntarily assumed the role of the paladin of medical truth who shall combat the evil misinformation proffered forth by ABC with this drama. Today I was actually surprised to find relatively little (in comparison with earlier episodes) with which to quarrel insofar as actual medical information is concerned, though situational and character realism remains quite a deficit in this program. Major points, in no particular order:

1) I really expected them to royally screw up the brain death issue. However, I think the writers sneaked in a consult from a real life person who knows something about medicine! In fact, patients with demonstrably absent brain activity and corneal reflexes undergo an observation period of six hours -- assuming that corroborative tests, such as an EEG, have been performed -- prior to the pronouncement of brain death. Interestingly -- and it's too bad the show writers didn't work this one into the storyline just for kicks -- brain dead individuals can actually exhibit a particular spinal reflex, aptly titled the "Lazarus reflex," involving the patient sitting up in bed . Oh well, that was a missed opportunity for dramatic sensationalism.

2) Based on this show, you would think that the only way any organs ever get donated is via surgical interns having the bright idea, "Hey, this guy's brain is dead, but his body isn't! We can donate his organs and save a few lives, but more importantly, WE CAN SCRUB IN ON AN ORGAN DONATION CASE! SWEET!" Nah, it doesn't work like that. Most hospitals have firmly established policies and procedures to ensure smooth harvesting and distribution of available organs, provided the family agrees and/or the patient's wish to donate was known in advance.

3) Donation matching isn't quite as quick and easy as checking the blood type. Most major organs, aside from the heart, are also typed according to major histocompatibility antigen proteins in order to reduce the risk of transplant rejection -- although newer anti-rejection drugs have made this increasingly less of an issue.

4) Most interns know how to speak to family members better than the character Cristina, who has all the tact and compassion of a yam.

5) Most interns don't scream, yell, and gesticulate while watching television, prompting you to suspect that perhaps the Super Bowl is on (and I'm playing WR, earning my ring), when in fact all they are watching are some old tapes of operative procedures. Enthusiasm is good; too much enthusiasm is pathologic.

6) A patient whose peritoneum has been punctured by nails (or whatever those metal foreign objects were that protruded from the belly of "Viper") does not present the next day with a wound dehiscence (i.e. wound falls apart)and an evisceration (i.e. bowel contents pouring out); the rent in the connective tissue would not be large enough. Rather, his peritoneum would simply become infected, and he would more likely return to the ED in septic shock. But sepsis is less exciting than bowels falling out, and with sepsis we don't get to see Ellen Pompeo (Dr. Meredith Grey) mounted up on top of the patient in some sort of medical heroics that also serves double duty as sexual innuendo.

7) Interns are busy. Repeat: interns are busy. Just in case you missed it, INTERNS ARE BUSY. They don't sit around in the E.D. waiting to cherry-pick the best patients, they don't spend all day and night in a brain dead patient's room, they don't observe every case that rolls through the O.R., and they don't somehow manage all to appear in the same place in the same time. In actuality, they find work constantly thrown upon them, in all the far reaches of the hospital, and generally make themselves scarce in all places but the patient floors where they have five thousand chores to complete before evening rounds. Watcing Grey's Anatomy, I almost begin to believe that my intern year will be easy easy easy. Apparently, it's all glamorous romance, subversive machinations (such as every time somebody defies Dr. Burke, who in reality would probably scalp somebody by now), and heroic holding of bowels in place! I can't wait for the fun to begin.


At 9:02 PM, Blogger Ian said...

Wow, that was a long post. Oops.

At 4:12 AM, Blogger phoenix said...

lol Tis ok on the long post as it was well worth the read. Welcome back Ian! Sorry you didn't have much fun at the party, but what prompted the punch anyway?

1 more day until House! hehehe

At 7:09 AM, Anonymous Anonymous said...

The show made it seem as if 'Viper' has sliced his abdomen open. A few puncture holes wouldn't given him a wound dehiscence.

Also, the entire organ donor matching procedure looked stupid. It's always never only the blood type and size of the body. If the donor liver too big to fit into the abdominal cavity, the surgeon could always choose a lobe to transplant into the patient.


At 7:17 AM, Blogger kingfelix said...

i am so jealous. i wish they had a show that was a relection, no matter how distorted, on my future. hmmmm, i can see it now, Stumblebum, coming this fall to Nickelodeon.

At 11:32 AM, Blogger Ian said...

Phoenix -- I had fun at the party taken as a whole, just not at the strip club. The kidney punch was entirely unprovoked -- just a random act of violence. And I'll try to watch House for sure.

Shirley -- Agreed. In fact, the liver they transplanted in this episode looked more size-appropriate to have come from a Cocker Spaniel than from a person. I think the heart is the only visceral organ for which HLA typing is not done (corneas don't need any matching at all, as far as I know).

Pinhut -- Stumblebum...isn't that the show about the famous writer who, in his early years, would build a string of successes only to suffer the repeated ignominy of having a bucket of green slime dumped on his head? Or am I mixing my Nickelodeon shows?

At 5:53 PM, Anonymous Kelly said...

Definitely check out House - about as medically accurate as anything else on television, but has some of the wittiest writing.

At 7:17 PM, Blogger phoenix said...

HAH!! Another House fan :)

The wit and humor in this show remind me a bit of M*A*S*H, but it has a very serious side as well and deep drama... but in a unusual way.

I think you will enjoy the show Ian.


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