*Side note: Some readers said this article is confusing without the backstory or summary of the episode. The focus of the blog-post is my analysis and reflection of an episode of the medical drama Grey's Anatomy titled "Don't Fear the Reaper." At the end of the peace there is a summary of the episode and several links for further explanation and detail.
Reflection of the Oyster:
In Grey's Anatomy Season 14 episode 11, the field of psychiatry is addressed. This is not just because the main character in this episode has a history of mental illness, but also to bring another example of how Dr. Baily is being ignored and misunderstood and has to advocate for herself. First, I want to say that I love this show, and I especially loved this episode. Although I will criticize how they misrepresented psychiatry, nevertheless I do like the mannerism and respect that was reflected in the actors portrayal of the shrink in this episode. Ironically, the psychiatric element was only able to be woven so well into this story because of Dr. Bailey's history of OCD, yet their respectful and deliberate approach to the topic when her mental breakdown first occurred was in stark contrast to this episode, where it was more of an afterthought, and in fact a classic example of how she was being dismissed. My sadness is that this actually is an accurate description of how many in the field of psychiatry see their profession yet it is so far from the potential of not just what this field could be, but of what the world needs it to be. Because of the strong mind-brain connection it is so important that the mentally ill be seen as not just patients, and definitely not as crazy, but as people with ideas, opinions, feelings, histories and even dreams and ambitions.
In this episode the Chief of Surgery of Grey Sloan Memorial goes to a hospital across town seeking treatment for a heart attack to avoid the personal and professional embarrassment of being treated by her colleagues. The downside is she is treated like any other patient and her self-diagnoses is discredited. She is patronized by staff attempting to make comforting hand gestures (stroking her hand as if she is a distraught teenager) who refuse to give her a cardiac stress test. Instead, when she asks for a second opinion, she is visited by a psychiatrist, who, to his credit looks sheepish and is very aware that he is the last person she wanted to see. This is probably true of most patients he consults on, definitely in the Emergency Room, and as a professional he does not take her rejection personally and tries to help her out. He rightly points out that given her history of mental illness, her stressful life challenges and her apparent lack of coping skills and familial/social support system. There are factors in her history that warrant his input on her case. She was right, he was wrong.
To get back to the story line of the episode for a minute, it all works out well in the end. Her colleagues come in and save the day, catching her when she faints and performing the minimally invasive life saving surgery just in the nick of time. Cherry on top: the episode ends with both her husband and mentor at her side as she calls her Mom and receives the love and reassurance only a Mom can give. In a spirit of forgiveness and redemption they wordlessly connect in a symbiotic healing of new and old wounds.
My critique of this episode is not of the episode, because the field of psychiatry is sadly very convoluted, and actually the portrayal in this story arc was closer to reality than the naive picture portrayed in her first bout with mental illness. Psychiatric drugs are not a guaranteed, quick fix, cure all. Even when medicine is required, it usually also requires behavioral and other psychological and therapeutic support services. Diagnoses and matching a psychotropic drug with the symptoms the patient is demonstrating is not a clear cut science either and can take many tries and trials until the right combination is found. Bailey was lucky the first time around. Usually the latter situation is true, where psychiatric patients are seen as crazy people with illogical and illegitimate ideas and requests. A psychiatric consult oftentimes means "she is your responsibility now;" as we see the cardiologist pawning off this annoying patient onto a doctor who was apparently bored enough to have time and patience to deal with her. Anything to get her off his service.
Instead, if she had psychiatric history, this should have been obtained much sooner, and the psychiatrist should be brought in out of respect: in recognition that this expert has ability to understand and interpret the emotional and behavioral factors that will impact his patient- no scratch that- this person's care, and to recognize that each patient is complex, and more than just the sum total of their symptoms. Even if the symptoms are most likely a result of anxiety, a full cardiac/ physical workup should be done. First of all, the psychological stress could be causing actual physical reaction. Isn't stress one of the risk factors and causes of many physical illness? Her mental health history should be cause for greater concern and scrutiny, not dismissal and avoidance. What is more to the point, is that there is no guaranteed way to determine if the symptoms are a sign of disease or a figment of her imagination. The only way to know for sure is to first rule out medical causes. If the refusal to do a full workup is not to exacerbate the OCD, that decision should only be made after first determining that no serious illness is being missed or overlooked. Then, the decision to not conduct the scan or test should be made with the consultation of a psychiatrist and with the agreement of the patient as part of a larger and comprehensive treatment plan. Another role the psychiatrist should be playing is to help the patient understand what is bothering them and advocate and articulate more clearly for their needs.
To end on a positive note, the psychiatrist character in this episode did address Dr. Bailey, the patient, with respect and engaged her in his thought process and decision making.
Side Note: In the last excerpt from the "Vulture" magazine summary, you realize that when doctors minimize a patient's pain and blame it on their emotions, that is dismissive. However, a smart doctor will see each patient holistically and both doctors and patients should realize that stress, emotions and other life circumstances do have a strong impact on a persons health and wellness.
Wikipedia Summary:
https://en.wikipedia.org/wiki/Grey%27s_Anatomy_(season_14)
With her intuition and the more subtle signs of a heart attack, Bailey winds up in the ER at Seattle Presbyterian; however, after her doctors treat her condescendingly, assuming she is imagining the heart attack and really just suffering from her OCD, she calls on Maggie to come save her. When Maggie arrives, she runs into Richard who found his way there based on Bailey's record of attendance. With her life flashing before her eyes, Bailey reflects on her upbringing and her past as a surgeon with all the stressful fights and struggles she has gone through to get to this point in her life. Right before she goes under for emergency surgery to save her life, Bailey asks Maggie to call Ben who is able to get there before she wakes up. Ben announces that he has quit being a firefighter, but Bailey demands that he go back and never do anything other than what he truly loves.
Bailey is a tough surgeon who serves as Chief of Surgery in the fictional hospital "Grey Sloane Memorial."
Richard is also a general surgeon who was the previous Chief of Surgery and her mentor.
Maggie is Richard's daughter and the Chief of Cardio-thoracic Surgery working under Chief Baily.
Ben is Baily's husband. the two met when he was working as an anesthesiologist. He transferred to a surgical residency when they became engaged and now at the end of his last year of residency he takes a break to pursue a "fellowship" as a paramedic/firefighter. This was one of the issues discussed with the psychiatrist; "It must be tough being the spouse of a first responder.""
imbd summary:
http://www.imdb.com/title/tt7044206/
The stress of managing the hospital and coming to terms with Ben's decision to become a Seattle firefighter pushes Bailey to her limits.
Excerpts of "Vulture" online magazine:
http://www.vulture.com/2018/02/greys-anatomy-recap-season-14-episode-11.html
Every so often a TV show you love airs an episode that feels as though it is a tiny gift the show made just for you, to thank you for that love. Most days, your relationship with that show feels very one-sided; some might say, “It’s all in your head, you crazy, it’s a TV show and also how long has it been since you left your apartment?” But then you get one of those episodes, and you just know. You know that they know you’re out there....
...when Bailey checks herself into Seattle Presbyterian because she knows she is having a heart attack and none of the dummy doctors will listen to Grey Sloan Memorial’s Chief of Surgery, it’s only natural to worry. We’ve seen other beloved surgeons enter hospitals that are not Grey Sloan and never return...
...Thankfully, Bailey comes out of this thing just fine (duh). But over the course of the episode...Miranda Bailey to teach us all another valuable lesson: Women need to be advocates for their own health. Remember back when Maggie joined the team and Jo tells her that Bailey doesn’t need to “bring any thunder” because Bailey is the thunder? Well, tonight Bailey is more than just the thunder, she’s the whole damn storm....
...She knows she is having a heart attack, but the initial tests show no signs of one. Bailey wants a full cardiac workup, but Dr. Maxwell, chief of surgery in this neck of the woods, repeatedly tells her that it isn’t necessary. It could be indigestion. Or stress. He wants to know if there are any major stressors in her life....
Instead of listening to his patient, Maxwell sends a shrink. The psychiatrist is even more condescending, if that is possible. When he blames Bailey’s feelings on stress and a little bit on her mental illness (sometimes I think Grey’s forgets Bailey has OCD), Bailey has to inform him of an alarming statistic: “63 percent of women who die suddenly from coronary heart disease have no previous symptoms, and women of color are at a far greater risk.” With that in mind, Bailey calls in the cavalry: She tells Maggie Pierce to get over to Seattle Pres immediately...
...Bailey’s health deteriorates fast and in a surprise to only the doctors at Seattle Pres, she has a full blown, active heart attack. Maggie tells Maxwell that this could’ve been avoided if he’d done a cardiac stress test....
...Then Bailey has to do the hardest thing next to having a heart attack: She has to call her mom and tell her about it. Bailey’s mom is still hanging out on the same porch swing from Bailey’s childhood, still scared by certain things, but she isn’t so scared for her daughter. Bailey tells her mom that she had surgery, but that she’ll be okay. Mrs. Bailey’s response is simple but moving: “I know you are. You’re my Mandy...”
http://tvline.com/2018/01/31/greys-anatomy-season-14-episode-11-spoilers-chandra-wilson-bailey-interview/
http://tvline.com/2018/02/01/greys-anatomy-season-14-episode-11-recap-bailey-heart-attack-flashbacks/
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