Grey's: The Grey's Anatomy Effect

I have to admit. Last night's Grey's Anatomy was a challenge for me to get through. The doctor in me had trouble abandoning all sense of reality.

I kept thinking "Meredith must have been under water for an hour while all that chaos was going on around her."

We all realize, I think, that no one can be under water for that length of time and live -- even if our brain metabolism comes to a screeching halt due to freezing cold water. But let'' just put that aside.

They get her out of the water and commence to bring her back to life. As they should have. But it goes on and on and on. Honestly, after 30 minutes or so of trying to resuscitate someone, chances are slim that they'll survive. Much less survive without serious brain damage. (registration required).

And 3 hours without a heartbeat? Then her heart starts beating, they pull out the breathing tube, she's talking in minutes, and everything's well in the world. Oh brother!

Then I decided to sit back and enjoy (something I should have done 30 minutes earlier). And I actually got caught up in the interesting way that the writers had Meredith's mother bring her back to life.

But the whole storyline made me think about a recent article I saw referring to the "Grey's Anatomy Effect." A poll from Junior Achievement Worldwide and Verizon showed that "Doctor" was a top career choice among teen-aged girls.

And someone made a comment that this may at least partly be due to medical shows like Grey's Anatomy or House.

There's no way to prove that, but if true, that's just scary.

The personal and professional lives of the doctors, the interns particularly, have very little to do with reality. When you're an intern, an 80 to 100 hour work week is normal -- and oftentimes more than that.

Interns frequently work shifts of 24 hours or more. While it's a very exciting time of your life, you're often wiped out. It's all you can do to stay awake at times -- much less think straight -- and when you're not working your butt off, you're sleeping.

We don't make a habit of having sex in a hospital bed. Or sitting at a bar in between seeing patients. Well, let's hope not.

My point is that if young boys and girls are seeing the lives of TV doctors and that makes them want to be a doctor, they're in for the shock of their lives.

There's no doubt that being a doctor is extremely rewarding -- just not in that way.

If your child is truly interested in being a doctor, have them spend some time talking to or actually spending a day with a doctor. See if your local hospital has programs for children interested in medicine.

And then if they still like what they see, send them on their way for years of hard --but fulfilling -- work.

Related Links:
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Addison is Subtracted from Grey's?

Looks like Dr. Addison Montgomery, (aka actress Kate Walsh) may get her own series, according a myriad of wire reports and one of our favorite blogs TV Squad.

Addison, as you all know, is a neonatal surgeon who spends her spare time collecting good-looking doctors as lovers and husbands. Currently on her trophy wall is Drs. McDreamy and McSteamy, and she is working on a relationship with Dr. Alex Karev.

So, can we stand two nights of Seattle-based medicine? Stay tuned.


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Grey's Greyless Anatomy?

We've all heard reports of someone -- usually children -- surviving despite being under water for 10 to 20 minutes in cold water. When someone experiences near drowning in cold water, brain metabolism does slow down, which is why people have survived such instances with no brain damage.

But by my estimate, Meredith must have been underwater for an hour or more during last night's Grey's chaos.

Let's just call it what it is -- pure entertainment with reckless abandon of medical accuracy. It made for great drama as long as we realize that's exactly what it is.

As a medical professional I have to take off my doctor's hat and just sit back and enjoy. Since I doubt they're going to change the name of the show to "Greyless Anatomy," Meredith will come through just fine.

Related Topics:

• Hypothermia Treatment
• Drowning: What To Do

Grey's: Painful Triage, Painful Lessons

The Grey's Anatomy episode "Walk on Water" opens with the interns participating in a triage drill in the hospital.

Izzie has just overlooked a major injury in the "patient," played by the dreaded chirpy resident. Izzie's mistake has just caused the patient to pretend to die. In what the interns believe is a continuation of the drill, the Chief announces that a real-life emergency has occurred and there are mass casualties. A ferry boat ran into a container ship -- time for triage for real.

So, exactly what is triage?

Triage refers to the evaluation and categorization of the sick or wounded when there are insufficient resources for medical care of everyone at once. In mass casualty situations like this one, triage is used to decide who is most urgently in need of transportation to a hospital for care (generally, those who have a chance of survival but who would die without immediate treatment) and whose injuries are less severe and must wait for medical care.

Triage is also commonly used in crowded emergency rooms and walk-in clinics to determine which patients should be seen and treated immediately.

Bailey, Meredith, Izzie, Alex, and George are taken to the accident scene and confronted with the horror firsthand. They're given medical kits and triage tags to categorize the injured as follows:

• Red tags- (immediate) those who cannot survive without immediate treatment but who have a chance of survival.

• Yellow tags - (observation) those who require observation (and possible later re-triage). Their condition is stable for the moment and are not in immediate danger of death. These victims will still need hospital care and would be treated immediately under normal circumstances.

• Green tags - (wait) the "walking wounded" who will need medical care at some point, after more critical injuries have been treated.

• White tags - (dismiss) those with minor injuries for whom a doctor's care is not required.

There are also black tags (expectant), for the deceased and also sadly, for those whose injuries are so extensive that they will not be able to survive given the care that is available.

The interns learn that even with this system, most of the victims need far more care and attention than is available or possible. While a surgical intern wouldn't singlehandedly be responsible for lifesaving measures in a hospital O.R., here in the field they experience what it's like when there's no senior staff member to ask for advice.

But even with this level of organization, with tags and practice drilling, and reviewing procedures over and over, there is no way to prepare the interns for what they see when they pile out of the transport vehicle and onto the scene.

It's chaos, studded with moaning children, bleeding rescued passengers litter the ground --some with severe, charred black burns. The injured and panicked are all around, while emergency crews buzz all around. In the background the barge burns, fire fighters battling the blaze.

Izzie sends a bystander for help for her critically ill patient, screaming that "he's a red tag" only to hear the answer that there are 15 "red tags" ahead of hers. Meredith can't apply pressure to a wound and rummage through her medical kit for instruments at the same time, so she relies on the help of a young lost child. And George discovers that there's no way to discover the whereabouts of his patient's 7-year-old son or to even know if he is alive.

It's a painful lesson.

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House: Autoimmune Me

Through another disease one-hour mystery tour, House and his ducklings waddle their way to a solid diagnosis by way of Wegener's Granulomatosis, another autoimmune disease.

Wegener's is rare and its hallmark is inflammation of small and medium-sized blood vessels, known as vasculitis. It primarily affects the upper respretory tract, lungs, and kidneys, but can involve other organs as well.

Poor Stevie, our young patient in question this week. While he tries to get lucky with a blond he is dating outside his Romani community, he turns slightly blue, ends up with House's crew, gets tested and prodded, and ends up nearly being a lab rat. And who knew toothpicks were so dangerous?

What's Romani? What testing? How can a toothpick be a weapon of mass destruction? Get the recap.

Now, back to autoimmunity. Though no one knows what causes Wegener's, it's thought to be an autoimmune disorder. And therein lies an interesting set of diseases in which the body attacks itself for reasons we don't understand.

While many of these diseases are rare, there are a few that are not so run-of-the-mill: type 1 diabetes, lupus, multiple sclerosis, and rheumatoid arthritis.

The mystery of why autoimmune diseases occur and how they affect the body, make them perfect fodder for a show like House, says Melissa Stoppler, MD, one of our medical contributors here at TV Checkup.

"I think writers may focus on autoimmune disease because this group of conditions are so variable and because autoimmune diseases can have so many difference clinical manifestations, giving the writers a lot of creative freedom."

And what of the mysterious non-FDA trials drug FT-28 drug they were pressuring young Stevie to take to help with his autoimmune disease? Dr. Stoppler says off-label drug prescriptions aren't uncommon. But they are always FDA approved drugs.

"However, doctors are not allowed to prescribe drugs that do not have FDA approval. New, not-yet-approved drugs may only be given in the context of rigidly-defined and controlled research studies known as clinical trials. To be considered for participation in a clinical trial, a patient must have met all the criteria for inclusion in the trial. For a doctor to fabricate a diagnosis in order for a patient to be entered into a clinical trial is a serious breach of ethics and constitutes malpractice."

And yet, malpractice is never the first thought in House's mind, is it?

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Grey's: Toxic Blood

In Thursday's episode, "Wishin' and Hopin" the interns and attendings of Seattle Grace are overcome by the toxic blood of cancer patient Marina. Just how did she get toxic blood? Supposedly the patient has been taking some kind of herbal remedy that has combined with the chemotherapy drugs to render her blood toxic.

So toxic, in fact, that the surgeons are rendered unconscious when she's on the operating table, and the mere procurement of a blood sample leaves George slurring his words and requiring immediate oxygen supplementation.

(For more on the show's other plotlines, visit Grey Matter, the writers' blog about the show.)

Unlike most of the Grey's plot lines, which have a theoretically-it-could-happen kind of novelty, this toxic blood idea seems more like something you'd see on House. Meaning that it's way out there. Unprecedented. As in VERY hard for this doctor to accept as remotely plausible.

Another thing that's very troubling is the scarcity of physicians available at Seattle Grace.

Cancer patient Marina is undergoing a bowel procedure, a general surgical operation to be performed by Richard. But when Richard and his team are overcome by the toxin, there obviously aren't any more general surgeons around. They have to call in neurosurgeon Derek and cardiothoracic specialist Burke to fix this girl's bowel. And when those two are out of commission, the team is now composed of plastic surgeon Mark, obstetrician Addison, and whoever among the interns they can happen to assemble.

Where, one might wonder, are the residents (those surgeons-in-training in the several years beyond the first-year internship)?

Still, there's a medical lesson to be learned from even this scenario, and that involves the combination of herbal or biological remedies with prescription medications. Herbal and alternative products are not subject to approval process of the FDA and cannot be legally marketed for the prevention or cure of disease.

However, the Dietary Supplement Health and Education Act of 1994 still allows these products to carry labels that suggest an effect on the structure or function of the human body or claim that they improve overall well-being.

Herbal remedies can have significant side effects. One example is the spontaneous bleeding that has been reported with Gingko biloba extract, which is advertised as improving cognitive (thinking) function.

Furthermore, the combination of herbal remedies and prescription medications can also interact in ways that are harmful to the body. gingko extract, to use the same example, is known to interact with anticoagulant and anti-platelet medications to influence the way these drugs can work in the body.

The bottom line - and the take - home medical message from this episode - is that herbal remedies should always be reported with your medication history since they can and do interact significantly with prescriptions that your doctor may prescribe.

Related Links: What Are Dietary Supplements?