Last week, I flirted with confessing that I have been watching "Grey's Anatomy." It started about two months ago, and I've felt a little embarrassed about this new habit.
The show drips in chick-flick sensibility. Calder sat through an episode, turned to me in disbelief at the end, and said: "you enjoy this?" Well, yes. I did.
So, okay, the writers haven't met a medical-drama cliche they don't like. No one could possibly have watched five seasons of "ER" without learning, for example, that the chatty lady accompanying her friend from the crash scene will be silently suffering from massive internal bleeding. In fact, it's hard to imagine any ER viewer failing at any time to predict the medical scenarios on Grey's Anatomy. But I didn't care.
I liked the cast. I liked the melodrama. I liked being snarky as I predicted the beats on each scene. I figured, who cares if the medical stuff is a mess? I can't tell, and Sandra Oh rocks. Also, I think I might be reverting to my youth, because Patrick Dempsey is, indeed, starting to look a little dreamy.
The honeymoon is over. The bubble has burst. The curtain has fallen on my infatuation. Time to retire the cliche.
Let's review a few salient details. First, the official episode description:
Meredith is mortified when her "one night stand" shows up at the hospital suffering from priapism and needing medical attention; a woman carrying quintuplets is overwhelmed by numerous medical issues as she navigates her high-risk pregnancy; and Alex's shortcomings frustrate Izzie.
Then, a quick explanation of the episode's theme, courtesy of the writers' blog:
We started thinking about this episode by asking ourselves, can you actually have too much of a good thing? You start with the obvious food, alcohol, drugs and soon realize these aren’t such funny or uplifting stories. They’re addiction stories and not really good things.
Then we read about this woman in Australia who had given birth to a set of quadruplets, got pregnant again and gave birth to a second set of quadruplets! Wow, what are the odds, right? That made us think, having a baby is a good thing, but what if you’re this Australian woman, didn’t you get a bit more than you bargained for with a second set of quads? Out of that came Dorie. Three boys are great [the character has two-year old triplets], but she wanted a little girl. She ended up with five girls [quintuplets], all with serious medical conditions [in the episode, only three have serious medical conditions]. What seemed like a good thing, suddenly became too much of a good thing.
You're reading this and thinking that it was the whole assinine approach to high-order multiples and ART that drove me crazy. But you're wrong! I was so overwhelmed by irritation and impatience with the medical management of the fictional pregnancy, I barely noticed the heavy-handed multiples theme. Fact is, Grey's Anatomy is all about the heavy-handed theme. I was ready to let that pass.
It was the rest of it that had me sitting there yelping in disbelief.
Where to start? Patrick Dempsey's character Derek has a wife, Addison Shepherd. She's just reappeared and been hired by Pacific Grace Hospital for her top-notch reputation as a neonatalogist. In this episode, however, Addison comes out as a dual specialist, tackling maternal-fetal medicine while (I presume) her NICU patients sleep. That's right, Addison Shepherd not only cares for neonates and their myriad health problems, she also handles high-risk pregnancies. Never mind that neontalogists are pediatricians who pursue advanced research and training in newborn medicine, while maternal-fetal specialists start their medical careers in obstetrics/gynecology and then pursue their own board certifications in high-risk pregnancy management. Addison can do it all, going from ultrasound monitoring and cesearean delivery to neonatal care.
No wonder McDreamy took her back. The woman's a medical phenom. Not to mention, with all that extra work she's doing, her compensation package must be off the charts.
Then check out that wonder-intern Izzie. Sure, she's working at the hospital as a first-year surgical resident, but she's not letting pesky little details like intensive years of specialization stop her. Under Addison's eagle eye, Izzie will skip all the trouble of learning pediatric medicine and advance immediately into neonatology. Because of course there's no such thing as intense competition for neonatal fellowships among the doctors who actually study pediatrics. Izzie the intern -- the surgical intern -- gets to plunge right in.
Then again, maybe we shouldn't get too carried away by the combined speciality-transcending talents of Doctors Addison and Izzie. After all, neither one of them appears to have learned the first thing about multiple-birth pregnancy. Neither one of them seems to know that the average quintuplet pregnancy only lasts about 30 weeks. In fact, none of the doctors at Seattle Grace takes action based on the idea that a 32-week quintuplet pregnancy represents a spectacular stroke of medical luck.
Of course, reaching 32 weeks barely scratches the surface of Dorie's gestational jackpot. Not only has she remained pregnant this long without (we infer from the dialogue) any hospital admission prior to this point, she's also managed her pregnancy almost entirely without medical supervision or intervention. How else to explain the many medical surprises she receives, once under Addison's superb care?
Here Dorie lies, 32 weeks pregnant with quintuplets, and over the course of a single day, she learns that one baby has hydrocephalus, another has hypoplastic left heart syndrome, and a third has an omphalocele.
Dorie's had the first quintuplet pregnancy in history to reach the third trimester without a single level-II ultrasound scan. Now that's amazing.
Almost as amazing as that 32-week quintuplet-swaddling belly, which looks smaller than some singleton bellies I've seen, and also happens to be entirely free of stretch marks.
Or the way that the 32-week babies, when delivered by emergency c-section while their mother lies awake on the table (someone having taken the time to call for an epidural), manage to look like the 26-weeker dolls used with such abandon over on ER.
Or the way that five surgical interns will, next week, pull duty in the NICU. Because NICUs aren't staffed with some of the most specialized caregivers in the entire hospital. Surgical interns will do their jobs!
How thrilling! How easy it shall be for me to suspend my disbelief!
Wow. I just go on and on, don't I.
Here, with slightly less snark, is a run-down of the the narrative problems on Grey's Anatomy this week:
Addison Shepherd is a neonatalogist. She might meet with a mother of quintuplets prior to her babies' delivery, especially after one or more babies had been diagnosed with complications in utero. Then again, she might not. I asked to speak to a neonatologist and got a couple of first-year residents, because the attendings were busy taking care of actual neonates. Regardless, the management of the pregnancy would be handled by a maternal-fetal specialist, and that person (probably in consultation with the relevant specialists for each baby's condition) would be the one making decisions about preterm labor.
Izzie is a surgical intern. She can't specialize in neonatal medicine.
Okay, that's not entirely precise. There do happen to be pediatric sub-specialties for most surgical specialities. For example, hypoplastic left heart syndrome would be managed by a pediatric cardiothoracic surgeon. Hydrocephalus would be managed by a pediatric neurologist. An omphalocele would be handled by a pediatric surgeon, possibly with the input and certainly with the follow-up of a pediatric gastroenterologist and a pediatric plastic surgeon.
Izzie could decide to pursue a pediatric surgery sub-specialty -- in three years -- and thereby work with premature and sick infants. But neonatology? If that's Izzie's goal, she better withdraw from the surgical program and start her pediatric residency immediately.
Of course, pediatric specialists sometimes care for adults, as well. Elba's pediatric plastic surgeon this summer was the chair of the ped plast surg department while also working the [adult] nose-and-boob-job curcuit. Nor must all these complicated medical conditions be handled by pediatric specialists. In an emergency situation, of course a cardiothoracic surgeon would perform surgery on a child. But hypoplastic left heart syndrome? That's a three-stage cardiac reconstruction (barring transplant) and requires a lifetime of follow-up care. The only people doing those surgeries and providing that care are pediatric cardiothoracic surgeons and their pediatric cardiologist colleagues.
Did you know that newborn blood vessels are the width of spaghetti strands? I learned that while watching the Discovery Health Channel. The Grey's Anatomy writers should try it sometime.
Unless Derek Shepherd has a pediatric sub-specialty we don't know about, he's not handling a baby diagnosed with hydrocephalus in utero. And I can't imagine he has that sub-specialty, because no one, least of all Dr. Google, would ever claim that prenatal hydrocephalus "just needs a shunt." Hydrocephalus that develops in utero indicates a brain or structural problem beyond the "mere" presence of excess fluid in the ventricles of the brain. Same thing with the omphalocele -- when a baby's internal organs form in a sack outside its abdomen, that almost always indicates further congenital defects. Certainly no chief resident of general surgery would ever handle an omphalocele case -- but that's how they handled it at Seattle Grace.
As for the delivery-room scene? Neonatalogists don't deliver babies. I would have laughed if I hadn't been so pissed off by the general narrative craptitude by then. OB/Gyns do cesearean sections. Even my semi-emergency triplet delivery was handled by OB/Gyn residents, under the supervision of the attending perinatologist on-call that night. Also, an emergency cesearean performed after a placental abruption during a quintuplet pregnancy? That's going to happen under general anesthesia. No one's going to take the time for an epidural to work, people.
As for the chaotic delivery scene, the scene conjured by the writers to demonstrate Addison's wicked skills for Derek's pleasure? NICU teams handle the babies at and after delivery. The folks rushing from the surgical field to the rescuscitation cribs? Those would be NICU nurses, probably two for each baby. Respiratory therapists and the neonatal attendings and the various pediatric specialists would all stand ready at the cribs, waiting to get to work. Surgical interns wouldn't even be in the room, unless they'd managed to bribe someone (not likely in the crowded conditions of a quintuplet delivery), and if they did manage to sneak in, their sole responsibility would be to stay the hell out of the way of the folks doing the work.
I'm either going to have to skip next week's episode, or self-medicate, because I will not be able to stay calm as an entire episode revolves around the surpassingly stupid conceit that five surgical interns are all assigned NICU duty.
Surgical residents don't do nurses' jobs: they don't have the knowledge or the skills. I was no fan of our NICU nurses, but those people do a wicked-hard job. What surgical intern would know the equipment, the warning signs, the thousand subtle pieces of wisdom necessary for a nurse to knit life to body as a newborn baby struggles? It's the nurses who know, almost by instinct, when to call for the specialists: and it's the specialists they call, not surgeons, certainly not interns.
Next week's episode is going to suck.
Worst of all, now I have to assume that all the medical stuff on this show sucks. This was just the first storyline where I knew enough to detect it.
Maybe there's still hope. Maybe Addison and Derek will crash and burn sooner rather than later. I'm agnostic on the the romantic troubles Addison causes for Meredith (I'm protected by my late arrival to the storyline), but I cannot bear any more assine forays into the world of high-risk pregnancy and neonatal medicine. If Addison sticks around, and keeps getting plots like this one, I'm going to have to give up my brand-new guilty pleasure.
Damn.

