Liana's Anatomy
*DISCLAIMER* This post contains spoilers from Grey's Anatomy..but I mean, if you haven’t thought to watch it in the past 13 years, what are you doin' sis?
I have come to the conclusion that there are two types of people who pursue work in healthcare. Those that watch doctor shows and enjoy them, understanding that there may be some inaccuracies and feel that it's ok because its literally fiction; and those that loathe them. Luckily for you, I fall into the first category.
If you’re like me, you know that the earlier seasons of Grey's are 100x better than the current episodes. I mean, did anyone else bawl their eyes out when Meredith had to cut Christina out of her wedding dress?
Right now we are in the Neuro block in my studies and I’m realizing how much neuro/psych was in Grey's Anatomy. So this post is me paying homage to one of my favorite shows and three things it helped me remember for my most recent test.
1. Robert Martin
Quick Recap: Season 2 Episode 10. Robert Martin is a 45 y.o. male who went to the hospital after he fell and it was later realized that he had a tumor on his pituitary gland. The tumor was also making Robert thirsty and causing him to drink so much water that it lowered his sodium (hyponatremia). So the attending (Derek) ordered the intern (Alex) to give Robert a hypertonic solution to balance his electrolytes before surgery, but Alex got the dose wrong and administered WAY to much which fried the patients brain.
It is believed that when too much sodium is administered too quickly, a shift in electrolyte balance causes swelling in the brain which can compress the nerve fibers and destroy the myelin that surrounds the axons. This is called Central Pontine Myelinolysis.
We learned that Central Pontine Myelinolysis can also occur in severe alcohol withdrawal. The specific mechanism may be different but it is the imbalance of water (osmotic changes) that prove to be neurotoxic and lead to the same problems.
When severe, the myelinolysis can lead to coma, “locked-in” syndrome (complete paralysis), and eventually death.
If you remember, this was a tough death for Alex because he knew he killed the patient and didn't want to leave the patient alone to die.
2. Kalpana Vera
Ok I’m having fun with this now.
Quick Recap: Next is the woman from Season 3 Episode 4. Her name was Kalpana. She presented in the hospital that day with recurrent fainting spells and her heart kept going into ventricular arrhythmia. She had a past medical history of Rheumatic Fever and valve stenosis.
So Christina (intern) automatically thinks she’s lying and is convinced when she sees the patient take a pill that wasn’t in her charts.
They run a bunch of tests on her and can’t find anything wrong.
In the end it turned out the woman was taking amitriptyline (an antidepressant) that can cause heart problems (including ventricular arrhythmias) as a side effect.
The disease that this woman had is called Factitious Disorder sometimes called Munchausen’s. This disease is characterized when one fabricates or exaggerates physical or psychological symptoms because they enjoy being in the sick role.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), patients can falsify signs or symptoms or induce symptoms (with drugs). They present as ill. Their behavior doesn’t have obvious external rewards (like money or drugs), but more for attention and sympathy. And patients are known to visit multiple hospitals (peregrination).
Factitious Disorder is a type of Somatic Symptom Disorder (SSD). SSD's are a class of psychological disorders where one has unexplained, genuine physical symptoms that are disrupting daily life for >6 months but can’t be physically diagnosed. Factitious disorder can be self-directed, like in the episode of Grey's or on someone else (formerly known as Munchausen’s by proxy).
Side note: this is the same episode when Christina finally breaks down after having surgery for her ectopic pregnancy. And I bawled in this episode too.
3. Rebecca Pope
Last one!
Quick Recap: Ya’ll remember Rebecca Pope from season 3? Karev rescued her from under a pillar when the ferry boats crashed at the harbor and called her “no-face girl" for a while. She ended up needing facial reconstruction surgery and went through a lot of psychological trauma associated with that.
Somewhere in there (I can't remember specifics), she ends up sleeping with Alex. I mean..it's Grey's anatomy, we need drama.
She then returns in season 4 because she believes she’s pregnant with Alex’s baby and because she wants breast enhancement surgery. She has some symptoms of pregnancy (sickness triggered by foods and feeling the baby “kicking”) but her blood tests return negative. And Dr. Sloan (may he rest in greys anatomy peace) says that they “could be looking at acute stress disorder, which can happen when people have massive plastic surgeries and major trauma. They don’t recognize themselves in the mirror, which can lead to really odd behavior.” Mark wants to make it clear to Rebecca that she’s not pregnant, then wants the intern to get her a psych consult.
We learned that the term for false belief of pregnancy is pseudocyesis (pronounced “soo-doh-sigh-ee-sis”) and according to the DSM-V, pseudocyesis is also a type of SSD, however, it falls under the “Not Elsewhere Classified” category of SSD's.
The patient with pseudocyesis can have objective findings including abdominal enlargement, reduced menstrual flow, amenorrhea, subjective sensation of fetal movement, nausea, and even labor pains at the expected date of delivery. And there have been cases where it happened to men!
For the test, all we needed to know was that pseudocyesis was a type of SSD but you see how much more we learned from Greys?!
If you were in the category that loves Grey's, I hope this post strengthened your bond. And if you were in the category that hated Grey's, I hope I have at least opened your mind to consider watching the earlier seasons.
So now if I go watch an episode right now, it counts as board prep right?