Sunday, April 17, 2005

Grey's Anatomy -- "No Man's Land"

I returned home just in time to grab some dinner and watch Grey's Anatomy. This episode, entitled "No Man's Land," had the following plot synopsis gleaned from the website:

Cristina's encounter with a former nurse, now a patient at Seattle Grace, changes her forever; Derek and Meredith treat a construction worker who has miraculously survived an injury but is now faced with tough decisions about his future; and a patient recognizes Izzie from a lingerie ad, which makes her the subject of hospital gossip.

This turned out to be a fairly entertaining episode, though the writers continue to take significant liberties with their presentation of the world of surgery. I present to you this week's list of gripes:

1) Interns do not all arrive at the hospital at the same time and don their scrubs to the accompaniment of the morning's motivational speech, compliments of the chief resident. Actually, interns will arrive at the hospital at varying hours depending upon the particular demands of the surgical service to which they happen to be assigned at the time. Also, 4:30am is typically not a time for loquacity; even if the chief resident were naturally inclined to speak at length about the day, her natural volubility would likely wane significantly at such an early hour.

2) Patients do not come to the surgical service to die. Even an ex-scrub nurse would likely receive admission to a standard medicine floor, though her status at the hospital might earn her a single-bed room.

3) I admit, words spoken through a surgical mask lose some of their impact, without the listener able to observe snarling lips and defiant clenchings of the jaw. Nonetheless, nobody removes a surgical mask in the middle of a procedure just to make a point; doing so compromises sterility, and it's a great way to find yourself kicked out of the room post-haste.

4) Sandra Oh's character, Cristina Yang, remains a hideously distorted caricature of the heartless surgeon in training. In this episode we watched her try to save a DNR (Do Not Resuscitate) patient who had come to the hospital to die; somehow, we are led to believe that this surgical cyborg had formed such a bond with her patient -- though no evidence of said bond ever became apparent in their interactions -- that she was pushed by a flood of emotion to forgo reason and sense in the interest of saving the patient's life at all costs. Well, I suppose that notwithstanding the problems of plausibility with this exchange, we can hold out hope that the writers might use this "epiphany" as a door through which to inject some semblance of humanity into a character who is otherwise as cold and sterile as the scalpel she aspires to wield.

5) I realize that essentially any injury -- conceivable or not -- can befall a person, and that practically everything -- including a head-full of nails accidentally incurrred -- has probably happened at some point in the history of medicine. However, falling down the stairs with a nail gun would more likely splinter the torso and legs with nails, rather than the top of the head, due to inherent limitations in the length of the arms and the standard manner with which one holds a nailgun (i.e. with the index finger on the trigger and the tip of the gun pointing away from the hand, a position from which it would be impossible to put a nail in the top of the head). Nonetheless, for the sake of argument let's assume that such a nail-ridden skull could result from a fall. These nails pierced the skull and entered the brain along its convexity, pointing inwards radially; although an optic nerve injury could result, as the show alluded to, most likely the patient would not escape without some damage to the motor or primary somatosensory cortex. The nails plunged right through these areas, judging by the head CT depicted. So "Jorge" would likely have had difficulty with movement or sensation of his face or his arms. As it turned out, the nails caused him essentially no harm, but a hypothalamic tumor caused his fall down the stairs. I didn't get the best look at the MRI showing the tumor, but operating too aggressively on a tumor in and around the hypothalamus can, indeed, lead to significant changes in memory and even personality.

6) Oh, one more thing -- any neurosurgery attending who has to have his interns perform a literature search in order to inform him that the risks of surgery include bleeding & infection, and that surgical outcomes are better when the procedure takes less time, really has no business cutting into somebody's brain in the first place.

Well, that's all I have for tonight. I could say much more, but I'm beginning to bore even myself, so I think it wiser for me to sign off for now.


At 8:18 AM, Anonymous Anonymous said...

I'm not too well-versed in neuroanatomy because I'm doing this module next semester, so I can't really offer any opinions on the hypothalamic tumour issue. I didn't catch that part too clearly, but did Dr. Shepard mention something about left-side weakness?

At least they got the resuscitation part correct this time. No defibrillators! Yay!

I feel like dumping this series on the backburner after this episode. It doesn't seem to have the sort of drive that I'm looking for.


At 11:49 AM, Blogger phoenix said...

Glad you are back Ian! I wish I had cable so I could watch this program just so I would know what you are commenting on.

BUT! House is on tomorrow night 9pm EST!! lmao Plan your night better this time k? hehehe

ta ta!!

At 1:00 PM, Anonymous Anonymous said...

Ok, if anyone thinks that this show remotely resembles real surgical residency needs to get a frontal lobotomy. For starters, if you've never been to a hospital: physicians are clustered into organ specific and disease specific teams: neurosurgery, cardiac surgery, abdominal surgery, trauma, etc. So a "general surgeon" would NEVER venture into a Neurosurgery case, or a cardiothoracic case. A general surgery resident DOES NOT ADMIT a patient with a primary diagnosis of epilepsy: THAT iS A GENERAL MEDICINE ADMIT. We don't gp trolling through the halls looking for patients, I mean really... WE ARE FAR MORE BUSY THAN TO TROLL FOR PATIENTS.. Also: When was the last time physicians were pushing patients around other than in the 1960s... I mean they are in SEATTLE, not some small 'burb so there will be orderlies. I wonder if they ever consulted with anyone in surgery before creating this show... Also if you didn't notice: people don't stand around in the operating rooms with their masks off.. Hello: Ever heard of sterility??? And lastly: I hate the way they portray surgery interns as doing anything to "get a case" as if we really aren't hear for patient CARE and not anything else...
- A concerned 4th year surgery resident

At 7:28 PM, Blogger phoenix said...

Not gonna do it, nope not gonna...

sigh... ok ok I am lol

Dear 4th year surgery resident,

The word is "here" not "hear". (Yes, I know it was a mistake but really now! I know you have to take english as part of your standard classes.)

Ian, I caved in and became the spelling police. ewwwwww save me!!!

At 8:22 PM, Blogger Ian said...

Shirley -- I was also glad to see they didn't try to shock any stilled hearts back into life. I understand your general sentiment about the show; I'm thinking that it may become increasingly difficult for me to find content about which to comment without becoming redundant, though I feel compelled to continue watching the show so I know what misconceptions it plants in the minds of the public. Plus, I want to see if George ever hooks up with Meredith. Ooops -- did that actually slip out?

4th Yr Resident -- I certainly agree with your points, as you can tell by reading my earlier posts about Grey's Anatomy.

Phoenix -- The show is on ABC! You should be able to see it if you can see House. In any case, I'll try to catch that show tomorrow. Oh, and feel free to serve as the grammar/usage police on my blog any time -- it spares me the urge to do it myself!

At 1:42 PM, Blogger Stuart Ressler, M.D. said...

I haven't seen the show, but back when I still owned a TV, I was somewhat hooked on ER.

Couple of observations on the blog entry and the other comments..
Maybe he fell down the stairs because of a visual field loss due to the pituitary tumor?

We've had some nail gun cases in the past, I wrote about one of them on my blog. Usually they're intentional, but a couple of times the patient insisted it was an accident. I have to agree with Ian, I've always wondered how exactly you do that by accident..

As for the admitting business, that does vary from one hospital to another. In our hospital, epilepsy is automatically a neuro admit, and the general surgeons (we call them trauma surgeons in the ER) admit the neurosurgical cases and consult the neurosurgeon only after the CT shows something that might arouse the interest of the neurosurgeon.
In another hospital I visited recently, the neurosurgeons (two of them, one at each end!) pushed their patient around the hospital, from the OR to the MRI and back. That was no emergency hospital though..

Also, in our unit masks in the OR are only required if you are part of the surgical team or move about the sterile area, near the drapings. In fact, masks worn by even the surgical team have been shown to have no effect at all on the sterility of a procedure. The results of those studies conflict with conventional wisdom so much that masks are still worn, and I'd certainly feel awkward operating without a mask on.

Nail guns are best used against the spelling police!


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At 11:55 PM, Blogger Antoinette said...

I've been a fan of Grey's Anatomy since it started to air. I find the drama too natural especially that I also work in the hospital. I'd love to know the drama of patients undergoing cosmetic surgeries such as botox. NJ, where I work, is also full of people are into cosmetic surgeries. They see its need to enhance how they look. Aside from botox, they also try procedures such as liposuction, laser treatments and blepharoplasty. NJ, the way I see it, could be the next capital in terms of cosmetics.

At 10:59 PM, Anonymous Grey's Anatomy Scrubs said...

I have written a blog that is about the best nurse scrubs that the Grey's Anatomy have been using on all there episodes. Read it at

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your URL gives only little description about the episode.

At 7:28 AM, Blogger Moe Satriani said...

There are a lot of things in this show that are not true. My father (who has been a doctor for years) was watching the show with me one night. My father actually has some greys anatomy scrubs that are modeled after the show. For a lot of surgeries, my father would say that they were doing the opposite of what should have been done for the operation. I just try to enjoy the show instead of finding all of the faults with it.


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