Anatomy Lesson

OK, I'm switching from bitterroot to cotton candy: let's talk TV. If confession is purifying, then it should help me to admit I watch medical shows: "Grey's Anatomy," "ER," even the ridiculous "House, M.D."

Readers of this blog know it, I'm sure; but I wonder how many people who watch Grey's Anatomy are aware of the word-play on the name of medicine's most famous anatomy text. Just asking. It's about the only way in which the show bears resemblance to reality, especially as applies to surgery training. I assume these shows have medical consultants. Wonder how much they get paid, and why the producers haven't called me...

Let's start with something mundane (OK, it's all mundane), but which I always find amusing. (Oh yeah: I also watch "Scrubs," and have wondered from the beginning why in the opening sequence JD puts the chest Xray up backwards. That's amusing, too; and puzzling. I'm thinking it's so obvious that they're doing it on purpose. But why.....?) The classic portrayal of surgery -- the actual act of operating -- is to show a surgeon (I particularly note that chief resident lady) sewing something. And without fail that surgeon tightens the suture by pulling the needle and needle-holder high above his/her head -- a regular quilting bee. In real life, raising one's hand that high is never done: for one thing, you're likely to whack it into an overhead surgical light. For another, it's clumsy as hell. Surgery is about control and stability. Which is why it's also a kick to watch the other enactments of operating: see how they hold instruments? High up on the handles, with their elbows out, hands far from the patient, as if stirring some mysterious stew? I doubt you even carve your steak that way.

In the operating room, a surgeon's hands are almost never flapping around like that. You want to rest them on something firm; if not the whole hand, then at least the pinkie, like a cane. Elbows in, hands and fingers close as possible to the patient. In fact, many surgeons avoid putting fingers in the "finger-holes" of instruments, placing that part in their palm, thumb on the mid-shaft and index finger nearly all the way to the end of the instrument. You can click and unclick the lock with the pad at the base of the thumb (the thenar eminence) opposing the middle or ring finger. (Naturally, some of my teachers were adamant that you NEVER do it that way....) I'll give them this much: it's pretty rare any more to see the actors at the scrub sink with the masks off their faces. Or contaminating their hands by washing backwards.

Watching "Grey's Anatomy," you'd conclude that surgery interns hang around together until some interesting case comes up, and then they fight for who gets to be involved. Heart, belly, uterus, whatever is next. In reality, you're assigned for a given time to a given service -- vascular, cardiac, ortho, several other options -- and that's what you do until you move on in a month or two or three. And you'll likely never see anyone who's not assigned there with you, except at big conferences.

Nor will you spend much time sitting around discussing (or performing) sex, or anything else. You'll be doing the work of admitting six or ten patients, in many of whose operations you'll likely not participate. You'll be running around collecting lab data, old records, Xrays. Into the wee hours, you'll be charting, writing orders, checking pre- and postop patients, taking calls for sleeping pills. Paging your superiors. And not only will you not be directly assisting the operating surgeon (and sure as hell you won't be doing the delicate parts of his operation so no one will notice his disability!! "We're a great team," he says. Give me a friggin' break, say I!), you'll be at least one body away from the action.

If you live with a bunch of fellow interns, your intercourse will consist mainly of leaving notes asking whoever ate your peanut butter to please replace it. I was one of twelve surgery interns, who rotated serially through the services, like a trunk/tail elephant parade. About half were one-intern shows, which meant I neither saw any of my fellows nor my apartment for a couple of weeks at a time. On the two-intern services, I shared with the same two all year: Wendell at the front end, and Mike at the back end of each two-month alloquot. Hardly knew the others at all. Sure as hell didn't screw any of them. Or my professors. Despite that "front end - back end" reference. Not a lot of lady surgeons, them days.

Will someone please enlighten me: what the hell sort of doctors are House and his groupies? I'm not talking about assholery: that part is clear enough. I mean specialty. In no big hospital that I know of would the same people sitting around thinking off over a patient be the ones to do all those procedures. Biopsies. Radiologic interventions. Of late they've tapered off a bit from their routine breaking and entering of their patients' homes; but they still seem to be doing pretty much everything else. Moreover, what exactly is their relationship? The groupies are too old to be residents, plus the black guy was once assigned to mentor House himself. So why do they spend all that time being lectured to and ordered around? Don't they ever have something else to do?

And really: I know poor ol' House is more drug-addled of late, but c'mon: not even stoned would any doctor mistake anything for four-limb necrotizing fasciitis. (Not only is there virtually no mechanism for getting it simultaneously in all four extremities, the patient would be dead too soon for a story line to develop.) It's inventive that the guy is a junkie. But after a while the formula wears thin: doctor-prick treats the patient like crap, makes about three wrong diagnoses, does a few unnecessary tests, putting the poor soul near the brink of death, then comes up with the right answer right before the closing credits. Every week, same damn thing. And yet: popular as pumpkin pie.

A quantum leap in realism was brought to the small screen with the advent of "ER," what with the roving camera and long takes; the failures, the confusion. But damn! With great regularity those patients seem to remain in the ER forever. Intubated, drugs dripping in. Like they're admitted there. Unless the ICU and recovery rooms are all overloaded, that just doesn't happen. Those guys have even opened bellies in their ER -- as big a no-no as there is. And let's not even talk about how often guns, bombs, and other disasters strike that place. Bad ju-ju. They need to see if it's built on an ancient cemetery or something.

Of course, it's all about entertainment, and not reality, and since when is reality all that entertaining anyway? In the grand order of things, it's a speck in the collective eye. But geez, aren't we doctors and nurses exciting enough that you could have a good show without just making shit up out of whole cloth?

I like everything about "Scrubs." Even the Xray.