Best of Grey's Anatomy: Sneaky Autopsy

Sneakiness abounds in Seattle Grace Hospital. Sneaky trysts in the supply closets, sneaky revelations about personal lives, sneaky procedures involving cutting LVAD wires to save the life of the boyfriend/patient...where does it stop? A while ago, there was a sneaky autopsy, too.

In the last episode of the first series, "Who's Zoomin' Who?", Meredith and Cristina perform an autopsy on the sly, on a patient whose family has flatly refused to consent to the procedure. Legally, of course, this is wrong. An autopsy (unless there are medicolegal implications) always requires the written consent of the next-of-kin of the deceased. Not only do the interns not have the required consent, but the family has expressly forbidden the procedure.

Autopsies are never performed on the whim of doctors to satisfy their intellectual curiosity, even if justified (in this case the docs discover a genetic disease in the family). And performing an autopsy without permission is the same as operating without permission -- grounds not only for dismissal, but also for revocation of a doctor's license to practice.

Ethically, it's also wrong, although the writers want us to decide whether the end justifies the means, giving us potentially life-saving information for the deceased's relatives. Granted, Meredith and Cristina obtained valuable information, but, morally, most people wouldn't be very pleased about wayward interns experimenting clandestinely on the body of a loved one.

Finally, logistically, this would be almost, if not absolutely, impossible to carry off. An autopsy is a medical procedure that isn't a one- (or two-) woman procedure; it is generally performed with the aid of technicians and personnel who help with preparation and processing of the body along with other tasks. It's also highly unlikely that two interns, even as bright as Meredith and Cristina are, could even interpret the autopsy findings without an experienced pathologist as guide.

Giving them the benefit of the doubt and assuming they could manage to perform a secret autopsy, it would be even harder to cover up, afterwards, the evidence of their having done so. Covering their tracks would require thorough washing of the autopsy suite, removal and disposal of contaminated materials, sterilization of contaminated instruments, and covering any and all traces of after-hours activity in the autopsy suite. The personnel at the funeral home would also undoubtedly notice that the body exhibited incisions from the non-permitted procedure, too.

So the autopsy scene, while dramatic, gets a "no" vote on the realism scale. And the hospital's official reaction? Thumbs down here, too. Such an action is grounds for dismissal from the residency program and revocation of medical licenses, and not even the fact that they're both sleeping with senior members of the department would be able to buy them some slack in this situation, were they in a real hopsital.

Related Topics: Grief & Loss Support Group

Technorati Tags: Grey's Anatomy, autopsy, pathologist

Who's the Most Handsome Doc of All?

Well, guess I won't be in the 2007 Hottest Doctors calendar. That, apparently, will be filled up with surgeons.

Every year the British Medical Journal (a very credible medical journal on most days but we all need to have fun sometimes) puts out an issue of crazy, but true, medical studies. And this year's issue had quite the doctor doozy.

According to the Spanish researchers, male surgeons are better looking than your average male doctor.

They even looked at TV docs like Dr. Shepherd (a neurosurgeon) -- aka "McDreamy" -- on Grey's Anatomy and Dr. House (on House). They found TV docs are the better looking than real-life docs regardless of their medical specialty. Shocker, huh?

I'm sure TV mailmen are better looking than your favorite postal worker, too. By the way, they didn't include female physicians because there weren't enough at their hospital.

So why did they do this study? I have no idea, but I had a great time reading it even though it didn't do a lot to build up my self-esteem.

Is it true? Well, maybe, but I'm not going to betray my internal medicine colleagues and vouch for their findings. I'll be thrown out of the club.

The researchers did have some quite interesting (or should I say humorous) theories as to why surgeons are better looking.

One possibility is our genes. It seems I may not be genetically programmed to be the most handsome doc or a doc that enjoys standing around a patient in the operating room for hours at a time. But thank goodness someone is.

The higher oxygen level in the OR (as opposed to the medical floor where other docs hang out) might also explain the surgeons' pretty tendencies. Or maybe the surgical masks are an effective anti-aging device (How? Who knows, but since wrinkle creams don't seem to work, might as well slap on a surgical mask and give it a shot).

Surgeons were also generally taller, which helps them tower over others in the operating room, allowing them to exert their dominance on their turf.

It seems that we ugly internists are weighted down with stethoscopes around our necks, causing us to stoop over and appear shorter. And then there's our apparent need to endlessly update our knowledge to stay up to date with the latest medical thinking. This endless reading of medical journals seems to grind us down even further.

Does that mean we're smarter? If surgeons get to be prettier, at least give us that.

So who tops your list of the hottest docs? "McSteamy" Dr. Sloan on Grey's, Dr. Kovac on ER, another TV doc, or your own personal physician? Let us know!

Related Topics:

Handsome Doctors in the Operating Room

Old Surgeons Still Good -- If Busy

Technorati Tags: handsome surgeons, House, ER, Grey's Anatomy, British Medical Journal

Is House Becoming a Cutter?

On top of his many problems, Dr. House has also been observed cutting himself. Most recently, in the throes of Vicodin withdrawal symptoms, House cuts his arm, arguing that endorphins released in reaction to the injury will help relieve his symptoms.

This is based on solid research on the part of the writers. Endorphins, discovered in 1975, are among the brain chemicals known as neurotransmitters, which function in the transmission of signals within the nervous system. Stress and pain are the two most common factors leading to the release of endorphins. Endorphins interact with the opiate receptors in the brain to reduce our perception of pain, having a similar action to drugs such as morphine and codeine (and Vicodin!). Unlike drugs, however, activation of the opiate receptors by the body's endorphins does not lead to addiction or dependence.

But cutting isn't a typical response of opiate addicts. Rather, this form of self-injury occurs predominantly in adolescents, particularly females, who are experiencing emotional issues such as depression, low self-esteem, or anxiety. Sometimes people self-injure because they feel empty or numb, because they cannot find another way to express their emotions, or because they perceive that the physical pain obliterates or possibly validates their emotional pain.

This doesn't sound like House. His motives seem more intellectual, a search for ways to mimic that Vicodin high. But there's a problem with his theory. Endorphin release varies among individuals - meaning that two people who exercise at the same level or suffer the same degree of pain will not necessarily produce similar levels of endorphins. So there's no guarantee that the cutting will even help his symptoms.

Further, there are activities that can trigger endorphin release that are far more pleasant than cutting. House doesn't strike me as the type who participates in strenuous athletics, but studies of acupuncture and massage therapy have shown that both these techniques can stimulate endorphin secretion. Sex is also a potent trigger for endorphin release. Finally, the practice of meditation can increase the amount of endorphins released in the body.

So it's unlikely that House will become a habitual self-injurer. Time will tell.

Related Topics:

When Scab-Picking, Cutting Becomes Addictive

College Students May Hide Self-Harm

Technorati Tags: House, cutting, self-harm, painkiller addiction

Doctor's Duds: A Fashion Emergency?

I remember the first time I put on a pair of scrubs. It really made me feel like a doctor. Funny how paper-thin, green clothes can help give you the confidence to care for patients (4 years of college, 4 years of medical school, and 3 years of residency help too).

Slip on a white coat over those scrubs and VOILA!...You really feel like a big shot.

But why do some TV doctors run around in scrubs and others in regular street clothes?

Most of the docs on TV are in medical training (as in Grey's Anatomy and Scrubs) or working in the emergency room (aka ER). In both of those settings scrubs are the norm.

Interns and residents are required to sleep overnight in the hospital a few times a week (well, that is if they get the opportunity to actually go to bed)and scrubs serve as great pajamas. If there's an emergency you have to be able to get to the patient as quickly as possible. And yes, that usually means you're wearing the same pair of scrubs for a day and a half.

And since the ER can be a messy place, scrubs just make more sense.

When's the last time your doctor walked into the office with a pair of scrubs? If your doctor is a surgeon, then it just may happen. Otherwise it's pretty unusual. By that point we've gotten our infatuation with scrubs.

And not all docs that spend a lot of their hospital time walking around in their greens and blues. It really depends on the area of specialty. Most of the docs on Grey's Anatomy are surgeons and therefore spend a lot more time in scrubs. But the docs on House appear to be more of the Internal Medicine variety and prefer the street clothes approach. This is pretty typical for real docs too.

But why do some docs wear the fancy surgical caps while others wear the poofy bouffant hats? It's all about personal preference. Some docs just don't care -- thus the awful poofy things. But other docs like to make a fashion statement. Grey's Dr. Burke, for instance, is apparently quite fond of his colorful headwear.

Doctors run around the hospital in their fancy scrub caps all day. Can you blame them since they probably haven't even had time for a shower? Imagine the bed head. And then there's the footwear. Doctors and nurses were wearing Croc-like shoes way before they were cool.

But don't those caps have to be sterile for surgery? Actually, they don't.

In order to decrease the risk of infection in patients, doctors and nurses go through a process called scrubbing. The cap isn't required to be sterile (its main use is to keep the hair contained so that it doesn't fall into the patient during surgery).

Scrubs aren't just for doctors. Head out to your local uniform store and grab yourself a pair. They're quite comfy to wear around the house.

Related Topics: ER Report Card: States Get Low Marks, Men Delay ER Trips to Watch Sports

Technorati Tags: Medical Fashion, Scrubs, Grey's Anatomy, House, ER

House: A Not-So Merry Little Christmas

The episode "Merry Little Christmas" finds Dr. House not so joyous himself as his sources of Vicodin are drying up. Aware of his little problem, his comrades have cut him off and informed the D.A., who has offered him a deal that would necessitate his going into rehab for two months.

House begins to exhibit some very characteristic symptoms of opiate withdrawal as he tries unsuccessfully to score more Vicodin. When drug addicts are accustomed to a particular level of drugs in their system and this level begins to fall, they experience the symptoms known as withdrawal symptoms. And this is exactly what's happening to Dr. House. We see him looking unkempt and miserable, complaining of nausea and vomiting. Abdominal pain, sweating, shaking, and rapid breathing are some of the other symptoms he's undoubtedly experiencing.

House being House, he still manages to diagnose a very rare condition in a case that has stumped his partners, despite his symptoms. Since withdrawal symptoms don't necessarily interfere with intellectual acuity, we'll just assume that his superhuman brainpower, which served him well throughout his addiction, is still working just fine, thank you.

He's certainly still clever enough to try to figure out some creative ways to get more Vicodin -- again, something not unusual for a highly-functioning addict. The bogus visit to a 24-hour clinic, armed with a convenient excuse regarding why all the milder pain meds won't work, and the attempt to steal another (deceased, in this case!) person's pills are both tried-and-true ways that addicts survive. Again, House being House, he eventually finds a way to dupe a pharmacist into letting him pick up drugs intended for the deceased cancer patient.

House enjoys Christmas Eve alone with a bottle of pills and a fifth of some form of liquid comfort, ending up in a pool of his own vomit. When Wilson finds him, it's odd that he leaves him there, since there is a great danger of overdose and death when relapsing drug abusers take more drugs to try to overcome withdrawal symptoms. I suppose he figures (rightly, as it happened) that House would pick himself up from yet another crisis, but still, that was quite a risk. Obviously Wilson has issues of his own, but he's just a supporting character, so we'll leave those alone for now.

Should House go into rehab? It would certainly make more sense than what he's doing now. In rehab centers, detoxification from drug addiction is carried out under medical supervision, with the aid of medications to manage the withdrawal symptoms. The teaser shown at the end suggests House will in fact be in rehab soon, which is bound to provide him (and the viewer) with some interesting escapades.

Related Topics:

Rehab's Role in Treating Addiction

The Price Tag of Chronic Pain

Technorati Tags: House, Dr. Gregory House, Vicodin, Drug Rehab

Docs Dating Docs

Meredith and Derek playing in the bathtub...Cristina jumping in the hospital bed with Preston...and George...well, George and Callie -- who knows?

Most of the interns on Grey's Anatomy are fooling around with one of their attending physicians. Does that really happen?

Believe or not, doctors are people too. When you're around someone practically every waking hour of the day, it's bound to happen. Just not as openly as on Grey's. But the plotline would come to a standstill if they always had to do it in the broom closet.

First, let's clear up the difference between an intern, a resident, and an attending. Interns have just graduated from medical school and are now doctors. They're fresh meat -- so to speak -- and low man on the totem pole.

An intern becomes a resident after one year of internship. Residency can last two or more years depending on the area of specialty. But once residency is done they're the big doc on campus and become attendings.

So the issue is that attendings -- and even residents -- hold a lot of authority over interns. And just the way that it's frowned upon for employees to fool around with their boss, the same thing generally holds true for docs in training.

That's why it's usually much more clandestine than on Grey's -- or ER or any other medical TV show.

But as we all know too well, reality can be even racier than TV.

Dr. Brunilda Nazario, WebMD's senior medical editor, remembers this "situation" when she was a resident:

"One attending I knew dated and married his intern. Both were married at the time. They tried to keep it a secret but everyone knew about it. They divorced their spouses and are still married today."

"But as an intern, she suffered academically. When the two did surgical procedures together, many people questioned why she deserved some cases she got. When she got into a fellowship program, he was the director of the program. She works as an attending in a program he heads and she continues to be frowned on."

WebMD medical editor, Dr. Louise Chang, says:

"It happens, but dating between interns and attendings is not considered professional. It's generally kept under wraps."

Like I said, docs are people too.


Technorati Tags: Grey's Anatomy, medical intern, resident physician, attending physician

Dr. House: Impaired but Functional?

A subplot in the latest episodes of House deals with Dr. House's own problem, his addiction to the painkiller Vicodin. It began innocently enough - when House needed the meds to control his chronic pain - but quickly spiraled out of control. Even while showing off his diagnostic prowess, House still finds the time to feed his habit.

By introducing the concept of House as an impaired physician, the writers let the viewers in on a little secret: House (like all doctors) is a human being, with human weaknesses. And sadly, House's drug problem actually represents a condition more common than the majority of medical issues portrayed on the show. Estimates suggest that approximately 2% of all physicians have a current substance abuse problem, and that between 8 and 18% of physicians will be impaired as a result of substance abuse at some point in their lives. Alcohol is the most common substance abused by physicians, but prescription opioids (House's drug of choice) and anti-anxiety medications are also commonly abused by those in the medical profession.

The notion of a doc with a drug habit is not novel. In fact, drug abuse is considered by many to be an occupational hazard of practicing medicine, and physicians historically have had high addiction rates. Combine a stressful job with the relative accessibility of drugs in a person who may be genetically or otherwise predisposed to substance abuse or addition, and there's physician impairment waiting to happen.

But is House really impaired in the strictest sense of the word? The U.S. Federation of State Medical Boards defines an impaired physician as:

One who is unable to practice medicine with reasonable skill and safety because of a mental illness; a physical illness or condition that adversely affects cognitive, motor, or perceptive skills; or substance abuse.

So far, House is probably still practicing within the limits of reasonable skill and safety, at least in terms of his usual performance. As with many addicts, outsiders likely would perceive him as functioning at a seemingly high level. And the numerous signs of drug addiction in physicians - the things colleagues are taught to watch out for - include bizarre behavior, mood swings, confrontational relationships, erratic habits, and inappropriateness. Fans of the series know where I'm going with this. Dr. House's unimpaired personality was, at best, unique and somewhat deviant from the norm. So at least some of the signs of addiction might simply go unrecognized in this character.

Is he going to defeat his addiction? Only the writers know for sure, but the odds are in his favor. Physicians are more likely than the general population to have a favorable outcome when treated for substance abuse, with recovery rates ranging up to 91% for docs in substance abuse treatment programs. Still, there's always the danger of relapse. We'll just have to wait for next season.

Related Topics:

RX Drug Abuse: Common and Dangerous

U.S. RX Painkiller Deaths Up

Technorati Tags: House, Vicodin, Painkiller Addiction

ER: The Ice Pick Man Cometh

You can have what's behind Curtain #1 or Curtain #2. Which would you like: The man impaled through the ear with an ice pick or the chatty gal who has swallowed her boyfriend's cell phone?

Both are the wacky situations portrayed on last week's episode of ER -- "Tell Me No Secrets."

The ER doctors are amazed that Ice Pick man has managed to impale himself in the left ear without hitting any major arteries.

However, the situation that really made me lift an eyebrow was that the ER doctors decided to attempt to remove the ice pick themselves...right there behind the curtain. To make things even more wacky, Hope, the intern, volunteers to retract the ice pick, under Dr. Morris's supervision. When she tugs, the handle breaks off, leaving just the end of the metal spike sticking out. Granted, they did attempt to pull in consults from neurosurgery and ENT, among other departments, and were put off. But, come on...would any ER doctor have taken that chance?

WebMD's Dr. Louise Chang probably wouldn't have. "I'd be worried that the ice pick would've penetrated the brain, in which case removal should've been done by neurosurgery."

And, Dr. Michael Smith adds:

"So what was the ice pick sticking into? That's the real question. It must have pierced something if it's sticking straight out of the ear. But it could be anything from the eardrum to the brain. My guess is somewhere in between. If it has gotten to the brain, that would mean it went through the skull and that's certainly not something you'd tackle in the ER (that's an immediate trip to the operating room to be performed by a neurosurgeon). If it's just the ear drum then, sure, you could pull it out in the ER. Regardless, the doc would need a good scan to evaluate where the ice pick is and exactly what they needed to do about it."

Now, draw back Curtain #2. There you find a babbling young woman who has swallowed her boyfriend's cell phone. She says he was getting calls from his ex-girlfriend so she took his phone and tried to keep it away from him. She didn't want him to get it back, so she just opened wide and down it went.

WHAT?

First I went into a fit of laughter, and then I pulled out my own cell phone. I held it in the palm of my hand. It's pretty small...maybe two inches wide and 3-1/2 to 4 inches long. Since I have a hard time swallowing a large vitamin, I just can't imagine I could toss back a cell phone, even the smallest one. And, if I did, wouldn't it get stuck in my esophagus? How real is this? Can it happen?

ER's fictional phone-swallower was not only breathing easy, but talking non-stop. And, the phone even begins to ring from inside her stomach.

Dr. Chang comments:

"I would've expected some problems with it getting stuck in the esophagus, which would require removal. If a foreign object makes it to the stomach, it can usually pass out through the stool. However, a cell phone is kind of large, so if it did make it to the stomach it would still probably cause a problem farther down the GI tract, possibly causing an intestinal obstruction or perforation which would warrant surgical removal."

Actually, this HAS happened before, but not exactly like it did on ER. In the real case, the woman was forced by her boyfriend to swallow the cell phone and it DID get lodged in her esophagus.

I guess those silly "Do Not Swallow" warnings that come on cell phone packages aren't so ridiculous after all.

Related Topics: Do Cell Phones "Excite" Your Brain?

Technorati Tags: ER, Ice Pick, Cell Phone, Swallowing Cell Phones

Grey's: Conjoined Twins, Saucy Interns

Last night Grey's Anatomy delved into the very interesting and intriguing lives of conjoined twins -- sometimes called Siamese twins after a set of conjoined twins born in the 1800s in Siam (today called Thailand).

Conjoined twins are very rare -- occurring in 1 in every 200,000 live births. It occurs more often than this but many of these twins are stillborn. And many of the live births die soon after birth. That's why coming across a set of conjoined twins is so rare.

But believe me, that wasn't the rarest thing I witnessed on Grey's. We'll get to that in a minute but let's just say I can't believe they said that.

First, a little more about conjoined twins -- another example of the wonders of the human body.

Conjoined twins are always identical because they form from one egg and one sperm. Under normal circumstances the fertilized egg splits within the first 2 weeks after conception -- leading to two genetically-identical but separate babies.

But with conjoined twins the splitting process happens too late causing incomplete separation of the two babies. By the way, there are no reported cases of conjoined triplets or quadruplets that I'm aware of.

I've read many reports of conjoined twins that are perfectly happy living side by side -- as hard as that may be for the rest of us to understand. But I guess it's all what we're used to and I have no doubt that conjoined twins have a connection (I'm not being funny here) that none of us can understand.

The risks of surgery to separate them is full of danger -- exactly the reason one of Grey's twins was so reluctant to have the surgery. Well, that and the fact that he was quite fond of his brother's fiancee and staying connected gave him easy access. During a sexual experience between one twin and his fiancee, the other twin copped a feel (and the fiancee didn't protest, so you can imagine how ugly it got).

It was actually quite a sweet story, albeit a bit out there, but that's what makes it fun.

Now onto the really rare events on Grey's.

Half the time when the interns talk to Dr. Bailey -- the chief resident -- they're smart-mouthing her. And the other half of the time they're off doing their own thing (another rarity we'll get into another time).

And Dr. Bailey isn't always the best at showing respect either.

For example, Dr. Bailey mouthed off to the chief of surgery (someone you would never even consider getting smart with) during the surgery to separate the conjoined twins.

She said, "Dr. Yang messed up and she's in the OR right now." Seems innocent enough to someone who doesn't truly understand the dynamics between residents and attendings. But the chief of surgery is as close to God as you get in the OR and it just doesn't happen that way (no matter what the resident is thinking).

But I can assure you all that discourse is far from the truth.

An intern is the low doc on the totem pole (often considered lower than low by many residents). It's just part of the process and we all go through it.

You do what you're told and you give your full respect to your residents and attendings (or at least act like you are).

Being an intern is all about paying your dues and one day you get to abuse your own interns (much like Dr. Bailey often does). Interns give their respect, so that they can earn others respect later on. And you get great memories from this experience.

Dr. Brunilda Nazario, WebMD's senior medical editor, remembers her internship this way:

"Being an intern was often brutal. Interns are often put on the spot with difficult questions -- we called it "pimping." And the interns were responsible for presenting a case much like Grey's interns often do. Then the residents and attendings would pummel you with questions -- the intern was like a sitting duck."

"There was a level of disrespect from interns, but it was all in fun. As a chief resident, my interns would sing "She drives me crazy" on rounds. It was a very popular song at the time."

Dr. Louise Chang, WebMD's medical editor, remembers her internship as a time of respect and admiration.

"An intern's quality of life is often dependent on the senior resident and attending that he/she is working with. Interns and residents speak to attendings with respect and professionalism. Attendings have tremendous responsibility, not only in charge of supervising their work but also teaching them and ultimately being responsible for any mistakes that the interns or residents make. This is huge, and an intern's deference is the norm."

The dialogue between Grey's interns, residents, and attendings make for a great script, but believe me, we wouldn't dare go there as an intern. And then there's the sex -- we won't go there right now.

Related Topics: 7 Key Traits of An Ideal Doctor

Technorati Tags: Grey's Anatomy, conjoined twins, Siamese twins, interns

Scrubs' John Dorian: Most Fertile Doc on TV

Scrubs finally returned this week (yeah!) on its new night at the same time as Grey's Anatomy (booo!) and just about everyone on the show is pregnant (weee!).

The season premiere of the medical comedy (medcom?) picked up where last season's cliffhanger left off with J.D. learning that his new girlfriend is pregnant despite that they've only been on two dates. Even more shocking, we learned last night that they never had intercourse.

It's probably best if I let J.D. explain in his own words: "There was some unexpected friendly fire, and even though I never got a chance to enter the village, there was an airstrike on one of the outlying regions. I spoke to the gals up in Ob/G, and they said it's not uncommon for a woman to get pregnant even if there was no actual penetration."

Kudos to the Scrubs crew for delivering the funniest dialogue ever written to describe premature ejaculation.

But is this really possible? Can a woman get pregnant without penetration? WebMD's Dr. Louise Chang explains:

A woman can get pregnant without penetration. If any sperm reaches the vaginal opening it can travel via her vaginal fluid. This could happen with body rubbing without intercourse or if you have ejaculate on your hands and have vaginal penetration that way. Keep in mind that there is usually pre-ejaculate (or sperm at the tip of the penis before ejaculation) that you may not notice. This also explains why the practice of withdrawal as birth control is not adequate.

Related Topics: Pregnant Pause: Ann Douglas Blog

Technorati Tags: Scrubs, pregnancy, John Dorian