Fact into fiction: House Organ story vs. Grey’s Anatomy story

by Leslie Hill

The writer of the April 2011 story on an innovative spine surgery that saved patient Judy Kerns’ life comments on the TV fictionalization of those events

When I was writing Judy Kerns’ story, I couldn’t stop talking about it. I found out about her radical neck reconstruction in December 2010, and ever since, whenever someone would ask me how work was going, I would give some excited, breathless summary of the story – “There’s this patient whose head had literally fallen off her neck, and one of our neurosurgeons, just weeks into practicing as a full-fledged surgeon, figured out how to build her a new one.”

Judy Kerns had her neck completely reconstructed by Matthew McGirt, M.D., after her head had literally fallen off her neck onto her chest.

The story was published in the April House Organ, and is here.

Everybody was so interested in the story that it was no surprise when I received an email saying that producers from the TV medical drama Grey’s Anatomy had contacted the surgeon who performed the surgery, Matthew McGirt, M.D., to get the details on the case and possibly include it in a future episode.

As a fan of Grey’s Anatomy since it premiered in 2005, I was giddy that even more people would hear Judy’s story. But would it even be recognizable after the television writers got finished with it? Everyone cautioned me no, and I had pretty low expectations myself.

So I wasn’t sure how I was going to feel about the episode when I sat down to watch it for myself. I knew the people, I was close to the story, and this had a chance to be either very cool or…not.

More photogenic than desperate

The theme of the episode is bad outcomes, and its moral stated as “The only thing worse than a bad surgeon is a scared one.” The main characters are fifth-year surgical residents, about to face board review and any bad outcomes will reflect unfavorably.

Cristina Yang decides to go on orthopaedics service for the week because “no one dies during a hip replacement.” She’s hoping for a shoulder dislocation but her attending orthopaedic surgeon Callie Torres says, “Do you think I’m going to bore you with routine crap?”

So the VUMC surgeon McGirt is going to be represented by Callie Torres. Who will be the episode’s “Judy Kerns?”

Turns out this “Judy” is a 20-something male named Tyler. The first, striking impression for someone who knows this story is that Tyler looks completely healthy, aside from his head slumping straight for the floor.

That is really different from the reality; Judy was near death when she arrived at Vanderbilt, driven to the ER by friends desperate to find her help. The angle of her neck prevented her from eating, and she had withered to 98 pounds. Her jaw had rubbed against her clavicle, eventually down to the bone, leaving an infected ulcer. Judy was desperate for a solution, and was willing to risk potential paralysis to have the surgery.

Tyler seems far more photogenic than desperate.

Good dialogue; bad medical decision-making

The medical information is more on-target. In fact, the rapid-fire explanation of the surgery is like déjà vu from my original story. Tyler has a degenerative bone disease and was in a car accident two years ago which further injured his neck (just like Judy!) and Callie is planning to build him a new one in a three-day, three-part surgery (just like McGirt designed!).

Later in the operating room, Callie explains to Cristina that today they’re taking out the old hardware, tomorrow removing scar tissue and then implanting a metal cage, roughly following the same course as the surgery performed at Vanderbilt by McGirt.

But TV surgeon Cristina, scared of bad outcomes, questions the procedure – why not just do a spinal fusion, which is standard procedure? Callie explains that Tyler has had four fusions already, and she’s going for a long-term approach. “But isn’t the risk of paralysis quite high?” asks Cristina. Callie’s response: “Only lame surgeons do fusions. We’re not lame. We’re fun. And badass!”

Pretty good dialogue, but not quite the mindset of McGirt throughout the month he cared for Judy. It took weeks of traction to lift her head up and heal the infected ulcer before he was even confident she could survive surgery. He worked with an orthopaedic device manufacturer to design the perfect custom implant for Judy. Then after every phase of surgery, the whole team stayed to see Judy wake up and wiggle her toes and know she wasn’t paralyzed . He wasn’t doing the surgery to be a “badass.” He was doing it because it was the only solution for Judy, and he was doing it very, very carefully.

As is typical on Grey’s Anatomy, the real drama for Tyler isn’t the risk of paralysis, it’s his parents. They fight continuously and he can’t wait to get better so he can move out.

During the third and final stage of the surgery, Callie finds that Tyler’s bones are so destroyed the screws won’t go in and the cage won’t fit. Again, Cristina pushes for a fusion, but Callie decides to close him up and figure out a new plan that’s “not a fusion.” Later, back in the OR, there’s some quick medical speak about three cobalt rods (just like McGirt designed!) and Callie gives Cristina a lecture about not being safe and boring.

Between what’s flesh and what’s fantasy

The surgery saved Judy’s life but left her with a completely rigid neck and some lingering pain. Instead, Tyler looks perfectly healthy in the recovery room, and seems to have full range of his neck. He even convinces his parents to get a divorce.

In the final scene, there’s a laptop open in front of him showing a scan of all the hardware in his neck that looks suspiciously like one McGirt showed me.

I had a front-row seat to see a piece of nonfiction—a story I had covered for more than three months and was very close to—turn into fiction. I went in knowing that Grey’s Anatomy is notoriously overdramatic, it’s medical cases just a vehicle for whatever emotional trauma the writers have dreamed up for the characters. I had low expectations but knew the writers had more than enough drama to create a great story.

They were surprisingly faithful to the medical details, but I expected the writers to capitalize more on the dramatic elements of Judy’s story. I envisioned a thin, frail patient with a dramatically drooping head and neck wound showing up at the ER with friends begging for something to be done.

While, in this alternative scenario, the patient spent weeks in traction to clear the infection, the surgeons could have argued about the best approach and how to design the hardware. Then they could have that tense period after surgery all standing around the bed waiting for the patient to wiggle his or her toes. Grey’s Anatomy writers live for those uncertain yes or no moments.

An opportunity missed in my opinion, but the writers had another agenda. Their story was about surgeons taking risks and about caring more for a patient’s well-being than holding back to prevent a bad outcome. And that is exactly what  McGirt did for Judy.

Read the original story in the April House Organ:

http://www.vanderbilt.edu/houseorgan/2011/03/unique-three-stage-spine-surgery-saves-womans-life/

Watch the full episode of Grey’s Anatomy:

http://abc.go.com/watch/greys-anatomy/SH559058/VD55149024/poker-face



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