‘Grey’s’ glosses over intern recklessness

The premise

IN the season finale of ABC’s “Grey’s Anatomy,” one of the surgical interns, Dr. Izzie Stevens (played by Katherine Heigl), crosses an ethical line by becoming romantically involved with a potential heart transplant patient, Denny Duquette (played by Jeffrey Dean Morgan). He has signed a Do Not Resuscitate order, but Izzie gives him hope that he will get a heart in time.

When two brothers are mortally injured in a car accident, it seems as if Denny will get a heart. Unfortunately, one of the hearts stops beating, is immediately deemed unusable, and the other brother’s heart is designated for another potential recipient who was placed on the list before Denny (by 17 seconds).

Izzie then deliberately cuts the pump lines of Denny’s heart’s left ventricular-assisting device. Emergency cases get priority, and his deteriorating condition will move him up the transplant list.

But Izzie’s disconnection of Denny’s assistance device (which initially caused the heart to stop) ultimately leads to his kidney failure.

The other surgical interns learn what is happening, but they don’t report Izzie’s behavior to the supervising resident.

When the truth comes out, the chief of surgery acknowledges that the hospital’s accreditation may be in jeopardy, but he takes no action and Izzie quits on her own.

Because of his worsening heart failure, Denny receives the heart that was intended for the other recipient, but dies afterward.

*

The medical questions

IS the heart transplant list so competitive? Is a prospective candidate allowed to sign a DNR order before surgery? Are interns so unsupervised that they are in a position to disrupt an emergency heart pump? Wouldn’t such a horrific event be cause for immediate arrest and discredit the training program? Is it realistic that if a donor’s heart stops, it is immediately rendered unusable?

*

The reality

THE jockeying for a heart transplant is very competitive, and a patient’s position on the transplant list -- in addition to the severity of his or her condition -- determine the order. However, a prospective heart transplant patient would never sign a Do Not Resuscitate order -- surgeons would not operate on such a patient because resuscitation may be necessary at any point.

Second, if a heart assistance pump were disconnected, a loud alarm would sound.

Third, interns could never monitor a sick heart patient for such a prolonged period of time without intervention by at least a nurse, if not a more senior physician. In the show, the interns watch Denny’s heart stop, resuscitate him, give him emergency medication -- all without observation or intervention. In real life, such a stunt would be cause for Izzie’s immediate arrest for attempted murder; the other interns would likely be kicked out of the residency program.

It is also unrealistic how little time is spent trying to salvage the first heart that was originally intended for Denny.

In fact, the only truly believable scene is the correct use of phenobarbital to put Dr. Meredith Grey’s dog to sleep because of incurable bone cancer.

*

Dr. Marc Siegel is an internist and an associate professor of medicine at New York University’s School of Medicine. He is also the author of “False Alarm: The Truth About the Epidemic of Fear” and “Bird Flu: Everything You Need to Know About the Next Pandemic.” In the Unreal World, he explains the medical facts behind the media fiction.