Break on Through (Season 2, Episode 15)

In surgery, there's a red line on the floor that marks the point where the hospital goes from being accessible to being off-limits to all but a special few.  Crossing the line unauthorized is not tolerated. 

In general, lines are there for a reason.  For safety.  For security.  For clarity. 

If you choose to cross the line, you pretty much do so at your own risk. 

So why is it that, the bigger the line, the greater the temptation to cross it?

We can't help ourselves.  We see a line, we want to cross it.

Maybe it's the thrill of trading the familiar for the unfamiliar.  A sort of personal dare. Only problem is, once you've crossed, it's almost impossible to go back.  But, if you do manage to make it back across that line, you find safety in numbers.

Tell Me Sweet Little Lies (Season 2, Episode 14)

As doctors we're trained to be skeptical because our patients lie to us all the time.  The rule is: every patient is a liar until proven honest.  Lying is bad.  Or so we're told.  Constantly, from birth.  "Honesty is the best policy."  "The truth shall set you free."  "I chopped down the cherry tree."  Whatever.  The fact is, lying is a necessity.  We lie to ourselves because the truth freaking hurts.

No matter how hard we try to ignore it or deny it, eventually the lies fall away, whether we like it or not.  But here's the truth about the truth: It hurts.  So... we lie.

Adrift and at Peace (Season 7, Episode 10)

The first twenty-four hours after surgery are critical.  Every breath you take, every fluid you make is meticulously reported and analyzed.  Celebrated or mourned.  But what about the next 24 hours?  What happens when that first day turns to two, and weeks turn into months?  What happens when the immediate danger has passed, when the machines are disconnected, and the teams of doctors and nurses are gone?  Surgery is when you get saved, but post-op, after surgery, is when you heal.  But, what if you don't?

The goal of any surgery is total recovery.  To come out better than you were before.  Some patients heal quickly and feel immediate relief.  For others, the healing happens gradually, and it's not until months, or even years later that you realize you don't hurt anymore.  So, the challenge after any surgery is to be patient.  But if you can make it through the first weeks and months - if you believe that healing is possible - than you can get your life back.  But that's a big if.

Slow Night, So Long (Season 7, Episode 9)

We doctors take pride in the fact that we can basically sleep standing up.  Anytime.  Anywhere.  But, it's a false pride, because the truth is, after about twenty hours hours without sleep, we might as well just come to work drunk, doctor, or not.  So, it's no wonder that fatal medical errors increase at night, when we doctors are, proudly, sleeping on our feet.  Recently, our communal pride has been shattered, and our egos have been wounded by new laws that require that we sleep all day before we work all night.  We're not happy about it, but, as someone who may one day need medical care, you really should be. 

Under the cover of darkness, people do things they'd never do under the harsh glare of day.  Decisions feel wiser.  People feel older.  But when the sun rises, you have to take responsibility for what you did in the dark, and face yourself under the cold, harsh light of day.

Something's Gotta Give (Season 7, Episode 8)

The human body is a highly pressurized system.  The blood pressure measures the force of blood pulsating through the arteries.  It's important to keep this pressure regulated.  Low or inadequate pressure can cause weakness or failure.  It's when the pressure gets too high that problems really occur.  If the pressure continues to increase, a closer examination is called for because it's the best indicator that something is going terribly wrong. 

Every pressurized system needs a relief valve.  There has to be a way to reduce the stress, the tension, before it becomes too much to bear.  There has to be a way to find relief, because if the pressure doesn't find a way out, it'll make one.  It will explode.  It's the pressure we put on ourselves that's the hardest to bear.  The pressure to be better than we are.  The pressure to be better than we think we can be.  It never, ever lets up.  It just builds and builds and builds.

Begin the Begin (Season 2, Episode 13)

Fresh starts.  Thanks to the calendar, they happen every year.  Just set your watch to January.  Our reward for surviving the holiday season is a new year, bringing on the great tradition of New Year's resolutions.  Put your past behind you and start over.  It's hard to resist the chance at a new beginning.  A chance to put the problems of last year to bed. 

Who gets to determine when the old ends and the new begins?  It's not a day on a calendar, not a birthday, not a new year.  It's an event.  Big or small.  Something that changes us.  Ideally, it gives us hope.  A new way of living and looking at the world.  Letting go of old habits, old memories.  What's important is that we never stop believing we can have a new beginning.  But it's also important to remember that amid all the crap are a few things really worth holding on to. 

Grandma Got Run Over by a Reindeer (Season 2, Episode 12)

It's an urban myth that suicide rates spike at the holidays.  Turns out, they actually go down.  Experts think it's because people are less inclined to off themselves when surrounded by family.  Ironically, that same family togetherness is thought to be the reason that depression rates actually do spike at the holidays.

There's an old proverb that says you can't choose your family.  You take what the fates hand you.  And like them or not, love them or not, understand them or not, you cope.  Then there's the school of thought that says the family you're born into is simply a starting point.  They feed you and clothe you and take care of you until you're ready to go out into the world and find your tribe.

Owner of a Lonely Heart (Season 2, Episode 11)

Forty years ago the The Beatles asked the world a simple question.  They wanted to know where all the lonely people came from.  My latest theory is that a great many of the lonely people come from hospitals.  More precisely, the surgical wing of hospitals.  As surgeons, we ignore our own needs so we can meet our patient's needs.  We ignore our friends and families so we can save other people's friends and families.  Which means that at the end of the day, all we really have is ourselves.  And nothing in this world can make you feel more alone than that.

Four hundred years ago, another well-known English guy had an opinion about being alone.  John Donne.  He thought we were never alone.  Of course, it was fancier when he said it.  "No man is an island entire unto himself."  Boil down that island talk, and he just meant that all anyone needs is someone to step in and let us know we're not alone.  And who's to say that someone can't have four legs?  Someone to play with, or run around with, or just hang out.

Much Too Much (Season 2, Episode 10)

When you were a kid, it was Halloween candy.  You hid it from your parents and ate it until you got sick.  In college, it was the heady combo of youth, tequila, and well, you know.  As a surgeon, you take as much of the good as you can get, because it doesn't come around nearly as often as it should.  Good things aren't always what they seem.  Too much of anything, even love, is not always a good thing. 

How do you know how much is too much?  Too much, too soon?  Too much information? Too much fun?  Too much love?  Too much to ask? And when is it all just too much to bear? 

That's Me Trying (Season 7, Episode 7)

Question: When was the last time a complete stranger took off her clothes in front of you, pointed to a big purple splotch on her back, and asked, "What the hell is this thing?"  If you're a normal person, the answer is, hopefully, never.  If you're a doctor, the answer is probably, "about five minutes ago."  People expect doctors to have all of the answers.  The truth is, we love to think that we have all of the answers too.  Basically, doctors are know-it-alls, until something comes along that reminds us we're not.

We're all looking for answers.  In medicine.  In life.  In everything.  Sometimes, the answers we're looking for have been hiding just below the surface.  Other times, we find answers when we didn't even realize we were asking the question.  Sometimes, the answers can catch us completely by surprise.  And sometimes, even when we find the answer we've been looking for, we're still left with a whole hell of a lot of questions.

Thanks for the Memories (Season 2, Episode 9)

Gratitude.  Appreciation.  Giving thanks.  No matter what words you use, it all means the same thing.  Happy.  We're supposed to be happy.  Grateful for friends, family, happy to just be alive, whether we like it or not.

Maybe we're not supposed to be happy.  Maybe gratitude has nothing to do with joy.  Maybe being grateful means recognizing what you have for what it is.  Appreciating small victories.  Admiring the struggle it takes simply to be human.  Maybe we're thankful for the familiar things we know.  And maybe we're thankful for the things we'll never know.  At the end of the day, the fact that we have the courage to still be standing is reason enough to celebrate.

Let it Be (Season 2, Episode 8)

In the eighth grade, my English class had to read Romeo and Juliet. Then, for extra credit, Mrs. Snyder made us act out all the parts.  Sal Scararillo was Romeo.  As fate would have it, I was Juliet.  All the other girls were jealous.  But I had a slightly different take.  I told Mrs. Snyder that Juliet was an idiot.  For starters, she falls for the one guy she knows she can't have.  Then she blames fate for her own bad decision.  Mrs. Snyder explained to me that when fate comes into play, choice sometimes goes out the window.  At the ripe old age of 13, I was very clear that love, like life, is about making choices.  And fate has nothing to do with it.  Everyone thinks it's so romantic.  Romeo and Juliet.  True love.  How sad.  If Juliet was stupid enough to fall for the enemy, drink a bottle of poison, and go to sleep in a mausoleum, she deserved whatever she got.

Maybe Romeo and Juliet were fated to be together, but just for a while.  And then their time passed.  If they could have known that beforehand, maybe it all would have been ok.  I told Mrs. Snyder that when I was grown up, I'd take fate into my own hands.  I wouldn't let some guy drag me down.  Mrs. Snyder said I'd be lucky if I ever had that kind of passion with someone.  And that if I did, we'd be together forever.  Even now, I believe that for the most part, love is about choices.  It's about putting down the poison and the dagger and making your own happy ending, most of the time.  And that sometimes, despite all your best choices and all your best intentions, fate wins anyway.

Something to Talk About (Season 2, Episode 7)

Communication.  It's the first thing we really learn in life.  Funny thing is, once we grow up, learn our words, and really start talking, the harder it becomes to know what to say.  Or how to ask for what we really need.

At the end of the day, there are some things you just can't help but talk about.  Some things we just don't want to hear.  And some things we say because we can't be silent any longer.  Some things are more than what you say.  They're what you do.  Some things you say because there's no other choice.  Some things you keep to yourself.  And not too often, but every now and then, some things simply speak for themselves.

Into You Like a Train (Season 2, Episode 6)

People can be categorized in one of two ways: those who love surprises, and those who don't.  I don't.

I've never met a surgeon that enjoys a surprise, because, as surgeons, we like to be in the know.  We have to be in the know, because when we aren't, people die and lawsuits happen.  Am I rambling?  I think I'm rambling?   Ok, so my point actually, and I do have one, has nothing to do with surprises or death or lawsuits or even surgeons.  My point is this: whoever said, "What you don't know can't hurt you," was a complete and total moron.  Because, for most people I know, not knowing is the worst feeling in the world.  Ok, fine, maybe it's the second worst.

As surgeons, there are so many things we have to know.  We have to know we have what it takes.  We have to know how to take care of our patients.  And how to take care of each other.  Eventually we even have to figure out how to take care of ourselves.  As surgeons, we have to be in the know.  But, as human beings, sometimes it's better to stay in the dark.  Because in the dark, there may be fear, but there's also hope.

These Arms of Mine (Season 7, Episode 6)

This was the "documentary" style episode, and there was no monologue for this episode.

Bring the Pain (Season 2, Episode 5)

Pain comes in all forms. The small twinge, a bit of soreness, the random pain.  The normal pains we live with every day.  Then there's the kind of pain we can't ignore.  A level of pain so great that is blocks out everything else.  Makes the rest of the world fade away.  Until all we an think about is how much we hurt.  How we manage our pain is up to us. 

Pain.  We anesthetize, ride it out, embrace it, ignore it.  And for some of us, the best way to manage pain is to just push through it. 

Pain.  You just have to ride it out.  Hope it goes away on its own.  Hope the wound that caused it heals.  There are no solutions.  No easy answers.  You just breathe deep and wait for it to subside.

Most of the time, pain can be managed.  But sometimes, the pain gets you when you least expect it.  Hits way below the belt and doesn't let up. 

Pain.  You just have to fight through.  Because the truth is, you can't outrun it.  And life always makes more

Almost Grown (Season 7, Episode 5)

They train doctors.  Slowly.  They watch us practice on frogs and pigs and dead people and then live people.  They grill us relentlessly.  They raise us, like children.  And eventually, they take a cold hard boot, and they kick us out of the nest. 

We all want to grow up.  We're desperate to get there.  Grab all the opportunities we can to live.  We're so busy trying to get out of that nest, we don't think about the fact that it's going to be cold out there.  Really freakin' cold.  Because growing up sometimes means leaving people behind.  And by the time we stand on our own two feet, we're standing there alone.

Can't Fight Biology (Season 7, Episode 4)

Biology determines much of the way we live.  From the moment we're born, we know how to breathe and eat.  As we grow older, new instincts kick in.  We become territorial.  We learn to compete.  We seek shelter.  Most important of all, we reproduce.  Sometimes biology can turn on us, though.  Yeah.  Biology sucks sometimes.

Biology says that we are who we are from birth.  That our DNA is set in stone.  Unchangeable.  Our DNA doesn't account for all of us, though.  We're human.  Life changes us.  We develop new traits.  Become less territorial.  We stop competing.  We learn from our mistakes.  We face our greatest fears.  For better or worse, we find ways to become more than our biology.  The risk, of course, is that we can change too much, to the point that we don't recognize ourselves.  Finding our way back can be difficult.  There's no compass.  No map.  We just have to close our eyes, take a step, and hope to God we'll get there.

Deny, Deny, Deny (Season 2, Episode 4)

The key to surviving a surgical internship is denial.  We deny that we're tired, we deny that we're scared, we deny how badly we want to succeed, and most importantly, we deny that we're in denial.  We only see what we want to see, and believe what we want to believe.  And it works.  We lie to ourselves so much that, after a while, the lies start to seem like the truth.  We deny so much that we can't recognize the truth, right in front of our faces.

Sometimes reality has a way of sneaking up and biting us in the ass.  And when the dam bursts all you can do is swim.  The world of pretend is a cage, not a cocoon.  We can only lie to ourselves for so long.  We are tired.  We are scared.  Denying it doesn't change the truth.  Sooner or later, we have to put aside our denial and face the world head-on, guns blazing.  Denial.  It's not just a river in Egypt.  It's a freaking ocean.  So how do you keep from drowning in it?  

Make Me Lose Control (Season 2, Episode 3)

Surgeons are control freaks.  With a scalpel in your hand you feel unstoppable.  There's no fear.  There's no pain.  You're ten feet tall and bulletproof.  And then you leave the OR.  And all that perfection, all that beautiful control, just falls to crap.

No one likes to lose control, but, as a surgeon, there's nothing worse.  It's a sign of weakness.  Of not being up to the task.  And still, there are times when it just gets away from you.  When the world stops spinning and you realize that your shiny little scalpel isn't gonna save you.  No matter how hard you fight it, you fall.  And it's scary as hell.  Except, if there's an upside to free falling, it's the chance you give your friends to catch you. 

Enough is Enough (Season 2, Episode 2)

I have an aunt, who, whenever she poured anything for you, would say, "say when!"  My aunt would say, "Say when," and of course we never did.  We don't say "when" because there's something about the possibility of more.  More tequila.  More love.  More anything.  More is better. 

There's something to be said about a glass half-full.  About knowing when to say "when."  I think it's a floating line.  A barometer of need and desire.  It's entirely up to the individual and depends on what's being poured.  Sometimes, all we want is a taste. Other times, there's no such thing as enough.  The glass is bottomless.  And all we want is more.

Raindrops Keep Falling On My Head (Season 2, Episode 1)

To be a good surgeon, you have to think like a surgeon.  Emotions are messy.  Tuck them neatly away and step into a clean sterile room where the procedure is simple.  Cut, suture and close.  But sometimes, you're faced with a cut that won't heal.  A cut that rips its stitches wide open. 

They say practice makes perfect.  Theory is, the more you think like a surgeon, the more you become one.  The better you get at remaining neutral, clinical. Cut, suture, close.  And the harder it becomes to turn it off... to stop thinking like a surgeon and remember what it means to think like a human being. 

Who's Zoomin' Who? (Season 1, Episode 9)

Secrets can't hide in science.  Medicine has a way of exposing the lies.  Within the walls of the hospital, the truth is stripped bare.  How we keep our secrets outside the hospital?  Well, that's a little different.

One thing is certain.  Whatever it is we're trying to hide, we're never ready for that moment when the truth gets naked.  That's the problem with secrets.  Like misery, they love company.  They pile up and up until they take over everything.  Until you don't have room for anything else.  Until you're so full of secrets, you feel like you're going to burst.

 The thing people forget is how good it can feel when you finally set secrets free.  Whether good or bad, at least they're out in the open, like it, or not.  And once your secrets are out in the open, you don't have to hide behind them anymore. 

The problem with secrets is, even when you think you're in control, you're not.

Save Me (Season 1, Episode 8)

You know how when you were a little kid and you believed in fairy tales? That fantasy of what your life would be.  White dress, Prince Charming who'd carry you away to a castle on a hill.  You'd lie in bed at night and close your eyes and you had complete and utter faith.  Santa Claus, the Tooth Fairy, Prince Charming - they were so close, you could taste them.

But eventually, you grow up.  One day, you open your eyes, and the fairy tale disappears.  Most people turn to the things and people they can trust.  But the thing is, it's hard to let go of that fairy tale entirely.  Almost everyone still has that smallest bit of hope, of faith, that one day they'll open their eyes and it will all come true.

At the end of the day, faith is a funny thing.  It turns up when you don't really expect it.  It's like one day you realize that the fairy tale may be slightly different than you dreamed.  The castle, well, it may not be a castle.  And it's not so important that it's happy ever after.  Just that it's happy right now.  See, once in a while, once in a blue moon, people will surprise you.  And once in a while, people may even take your breath away.

The Self-Destruct Button (Season 1, Episode 7)

Okay.  Anyone who says you can sleep when you die?  Tell them to come talk to me after a few months as an intern.  Of course, it's not just the job that keeps us up all night.

If life's so hard already, why do we bring more trouble down on ourselves?  What's up with the need to hit the self-destruct button?

Maybe we like the pain.  Maybe we're wired that way.  Because without it... I don't know... Maybe we just wouldn't feel real.

What's that saying?  Why do I keep hitting myself with a hammer?  Because it feels so good when I stop!

Superfreak (Season 7, Episode 3)

Most surgeons grew up being freaks.  While other kids played outside, we holed up in our rooms.  Memorizing the periodic table.  Huddling for hours over our junior microscopes.  Dissecting our first frogs.  Imagine how surprised and relieved we were when we grew up and found out there were others out there just as freaky as we were.  Same microscopes.  Same dead frogs.  Same inexplicable urge to take human beings apart.

Nobody chooses to be a freak.  Most people don't even realize they're a freak until it's way too late to change it.  But no matter how much of a freak you end up being, chances are there's still someone out there for you.  Unless, of course, they've already moved on.  Because when it comes to love, even freaks can't wait forever.

If Tomorrow Never Comes (Season 1, Episode 6)

A couple hundred years ago, Benjamin Franklin shared with the world the secret of his success.  "Never leave that 'til tomorrow," he said, "which you can do today."  This is the man who discovered electricity.  You'd think more of us would listen to what he had to say.  I don't know why we put things off, but if I had to guess, I'd say it has a lot to do with fear.  Fear of failure, fear of pain, fear of rejection.  Sometimes the fear is just of making a decision.  Because, what if you're wrong? What if you're making a mistake you can't undo? 

Whatever it is we're afraid of, one thing holds true.  That, by the time the pain of not doing a thing gets worse than the fear of doing it, it can feel like we're carrying around a giant tumor.

The early bird catches the worm.  A stitch in time saves nine.  He who hesitates is lost.   We can't pretend we haven't been told.  We've all heard the proverbs, heard the philosophers, heard our grandparents warning us about wasted time, heard the damn poets urging us to seize the day.  Still, sometimes, we have to see for ourselves.  We have to make our own mistakes.  We have to learn our own lessons.  We have to sweep today's possibility under tomorrow's rug until we can't anymore, until we finally understand for ourselves what Benjamin Franklin meant.  That knowing is better than wondering.  That waking is better than sleeping.  And that even the biggest failure, even the worst, most intractable mistake beats the hell out of never trying.

Shake Your Groove Thing (Season 1, Episode 5)

Remember when you were a kid and your biggest worry was, like, if you'd get a bike for your birthday or if you'd get to eat cookies for breakfast?   Being an adult, totally overrated.  I mean, seriously, don't be fooled by all the hot shoes and the great sex and the no parents anywhere telling you what to do.  Adulthood is responsibility.  Responsibility, it really does suck.  Really, really sucks.

Adults have to be places and do things and earn a living and pay the rent.  And if you're training to be a surgeon, holding a human heart in your hands... Hello!  Talk about responsibility!  Kind of makes bikes and cookies look really, really good, doesn't it?  The scariest part about responsibility?  When you screw up and let it slip right through your fingers.

Responsibility.  It really does suck. 

Unfortunately, once you get past the age of braces and training bras, responsibility doesn't go away.  It can't be avoided.  Either someone makes us face it, or, we suffer the consequences.  And still, adulthood has its perks.  I mean, the shoes, the sex, the no parents anywhere telling you what to do... that's pretty damn good.

No Man's Land (Season 1, Episode 4)

Intimacy is a four syllable word for, "Here are my heart and soul.  Please grind them into hamburger and enjoy."  It's both desired and feared.  Difficult to live with, and impossible to live without.

Intimacy also comes attached to life's three "R's": Relatives, romance and roommates.

There are some things you can't escape, and other things you just don't want to know.

I wish there were a rule book for intimacy.  Some kind of a guide that could tell you when you've crossed the line.  It would be nice if you could see it coming.  And I don't know how you fit it on a map.  You take it where you can get it and keep it as long as you can.  And as for rules?  Maybe there are none.  Maybe the rules of intimacy are something you have to define for yourself.

Winning a Battle, Losing the War (Season 1, Episode 3)

We live out our lives on the surgical unit.  Seven days a week, fourteen hours a day.  We are together more than we are apart.  After a while the ways of residency become the ways of life.

Number one: always keep score.

Number two: Do whatever you can to outsmart the other guy.

Number three: Don't make friends with the enemy.

Oh, and yeah, number four: everything, everything is a competition.

Whoever said winning wasn't everything never held a scalpel.

There's another way to survive this competition.  A way no one ever seems to tell you about.  One you have to learn for yourself.

Number five: It's not about the race.  At all.  There are no winners or losers.  Victories are counted by the number of lives saved.

And once in a while, if you're smart, the life you save could be your own.

The First Cut is the Deepest (Season 1: Episode 2)

It's all about lines.

The finish line at the end of residency.

Waiting in line for a chance at the operating table.

And then there's the most important line: the line separating you from the people you work with.

It doesn't help to get too familiar, to make friends.  You need boundaries between you and the rest of the world.  Other people are far too messy.

It's all about lines.  Drawing lines in the sand.  And praying like hell no one crosses them.

At some point you have to make a decision.

Boundaries don't keep other people out.  They fence you in.  Life is messy.  That's how we're made.

So, you can waste your life drawing lines, or you can live your life, crossing them.

But there are some lines that are way to dangerous to cross.

Here's what I know: If you're willing to take the chance the view from the other side is spectacular.

A Hard Day's Night (Season 1, Episode 1)

The game.

They say a person either has what it takes to play, or they don't.  My mother was one of the greats.  Me, on the other hand?  I'm kind of screwed.

I can't think of any one reason why I want to be a surgeon, but I can think of thousands why I should quit.  They make it hard on purpose.  There are lives in our hands.  There comes a moment when it's more than just a game, and you either take that step forward, or turn around and walk away.

I could quit, but here's the thing: I love the playing field.

Shock to the System (Season 7, Episode 2)

They say lightning never strikes twice, but that's a myth.  It doesn't happen often.  Lightning usually gets it right the first time.

When you're hit with thirty thousand amps of electricity, you feel it. It can make you forget who you are. It can burn you, blind you, stop your heart, and cause massive internal injuries. But for something that happens in only a millisecond, it can change your life forever.

Lightning doesn't often strike twice.  It's a once in a lifetime thing.

Even if it feels like the shock is coming over and over again, eventually, the pain will go away, the shock will wear off, and you start to heal yourself. To recover from something you never saw coming. 

But sometimes the odds are in your favor.  If you're in just the right place, at just the right time, you can take a hell of a hit, and still have a shot at surviving.

With You I'm Born Again (Season 7, Episode 1)

“Every cell in the human body regenerates, on average, every seven years. Like snakes, in our own way, we shed our skin. Biologically, we’re brand new people. We may look the same—we probably do. The change isn’t visible—at least not in most of us—but we’re all changed. Completely. Forever.

When we say things like ‘people don’t change,’ it drives scientists crazy. Because change is literally the only constant in all of science. Energy… Matter… It’s always changing. Morphing. Merging. Growing. Dying.

It’s the way people try not to change that’s unnatural. The way we cling to what things were instead of letting them be what they are. The way we cling to old memories instead of forming new ones. The way we insist on believing, despite every scientific indication, that anything in this lifetime is permanent.

Change is constant. How we experience change… that’s up to us. It can feel like death. Or it can feel like a second chance at life. If we open our fingers… loosen our grips… go with it… it can feel like pure adrenaline. Like at any moment, we can have another chance at life. Like at any moment, we can be born all over again.”