Our In-House Dermatologist on the Cringeworthy ‘Game of Thrones’ Greyscale Surgery Scene

Sam’s #NotEvenAMaester, but his enterprising work on Jorah shocked and awed

Warning: This post contains images that are graphic in nature. Eat your hot pie before you proceed.

Game of Thrones is unique in the annals of television history for many reasons, but none more profound than this: It creates a fantasy world simultaneously so expansive and so minutely detailed that it becomes an unparalleled substitute for our real one. Other shows may have created a world easier to lose yourself in, but between the gorgeous sets and scenery, the backstory that reaches thousands of years into the past, and the textual canon of thousands of pages that, like a Mandelbrot set, becomes more intricate the closer you look — no show has created a world harder to find your way out of.

The escapist thrill of the show derives from the fact that there is simply no analog in real life to the characters’ daily experiences. If you’ve ever been in danger of being flayed alive, roasted by a dragon, zombified by a wight, or — worst of all — bedded by your sibling, you’ve lived a very different life than the rest of us.

For me, at least, that was the appeal of the first six seasons: to vicariously experience the lives of strangers in a world I wouldn’t want to set foot in for a second.

And then Samwell Tarly began his training at the Citadel, and I started having flashbacks to medical school.

The Citadel montage in “Dragonstone,” the first episode of the seventh season, is comical for all the obvious reasons, but for anyone who’s been a third-year medical student, it had an extra layer of humor: It’s funny because it’s true. Steve Allen said “Tragedy plus time equals comedy,” and 20 years later I can laugh about the fact that I know exactly what Samwell was going through: Scrubbing shit out of bedpans is a task thankfully consigned to previous generations of medical students, but the vestiges of that treatment still remain, with third-years performing all the tasks too unpleasant for anyone with the pull to get out of them.

There is literally no part of Jon Snow’s life that I can relate to. But being forced to listen to Archmaester Ebrose while he drones on and on only to have him, once you’re finally permitted to get a word in edgewise, politely listen while making it clear that your opinion doesn’t count for squat? Being so desperate for something interesting to pull you out of the drudgery of your daily life that a freaking autopsy — weighing human organs on a scale like they’re on sale at Safeway for $5.99 a pound — comes as sweet relief? That I can relate to: I’m a doctor.

If this season’s first episode was Samwell’s punishment for his career choice, the second episode was his reward. In the real world it takes years to progress from the bottom of the totem pole to the point where you are wielding a scalpel, but thanks to the magic of television, the time-lapse effect of the montage scene, and Samwell’s willingness to risk his career to save the life of the son of his former Lord Commander, it took him only one week in our world.

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While I’m familiar with Samwell’s punishment, I’m also familiar with his reward, because after finishing medical school, I specialized in dermatology. I love my job, but there may be no part I love more than performing surgery to remove a cyst — the oozier the better. What most people get to see only in a Tosh.0 clip I get to do on a regular basis. No one said life is fair.

So when Samwell rolled a medieval surgical cart into the greyscale-ridden Jorah Mormont’s hospital room/Citadel cell and told him, “You’re not dying today, Ser Jorah,” like a Syrio Forel–level badass, I’m not going to lie: I got intensely jealous. I knew what was about to come. And I knew it was going to be awesome.

Let’s go to the tape, shall we?

(Screenshots via HBO)

Proper preparation is a prerequisite for a successful surgery. Have all the supplies you might possibly need on hand before you start. Samwell walks in with a complete set of surgical tools and an impressive number of powders and unguents. Proper wound care following surgery requires coating the area with a thick layer of ointment. Samwell appears to have done his homework.

“Drink this.”

“What is it?”

“Rum. Drink it all, please, I’m afraid this is going to hurt.”

As a physician/acolyte maester, your first priority must be to establish trust with the patient. Honesty is the foundation of trust. The easiest way to violate that trust is to tell a patient something isn’t going to hurt when it is. Unfortunately, too many doctors do just that, apparently believing that if you just don’t tell the patient they might not notice the debilitating pain.

This is a common rookie mistake, so give credit to Samwell, the very definition of a rookie, for avoiding it.

Generally it’s considered bad form to have your textbook out for the patient to see during the procedure. As much as possible, you want to sustain the illusion that you know what you’re doing, and nothing says “I don’t know what I’m doing” like checking the manual right before the procedure. You’re performing surgery, Samwell, not putting together a Lego TIE Fighter.

But the reality is that Samwell doesn’t know what he’s doing, and more than that, no one knows what he’s doing — this procedure hasn’t been attempted for ages. So we’ll let this one slide.

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“If you wouldn’t mind, bite down hard.”

Pain management has been a vital part of surgery since the first caveman lanced a boil with a sharp rock. Unfortunately, until the development of ether in the mid-1800s, “pain management” literally meant a surgeon with the strength to saw through bones in under 15 seconds and surgical assistants with the strength to hold the patient still for 15 seconds. Samwell has neither, but between the rum and a strap for Jorah to bite down on, he does the best he can with what he’s given.

“Have you ever done this before?”

“… no. No one else will try, and so I’m the best you got.”

Honesty is the best policy. That doesn’t mean you have to volunteer unpleasant information, but when you’re asked a direct question from the patient, an uncomfortable but candid answer in the moment saves everyone a whole lot of discomfort later.

And here we have first contact. Textbook form by Samwell, really — a good strong grip of the forceps with one hand, coming in at close to a perpendicular angle, while the sharp side of the scalpel is angled almost parallel to the skin. He’s a natural.

Most physicians in training instinctively recoil the first time a patient’s body responds angrily to their ministrations by emitting some sort of fluid. But Samwell handles it like a champ — he doesn’t hesitate at all, except to shush Jorah one more time before continuing to peel off his skin.

Mere seconds in, Samwell is already making good progress. He’s peeling through Jorah’s skin without a ton of effort, which suggests either that his scalpel is extremely sharp — which, given that Samwell’s instruments look like they date from before Aegon’s conquest, seems unlikely — or that the nature of greyscale itself makes a patient’s skin easier to peel.

At this point, Samwell gives Jorah a look, as if to say “here it comes.” Samwell is fully committed to the act, not allowing Jorah’s agonizing pain to distract him from the job at hand. As I tell my patients before I stick them with a needle, “If it makes you feel any better, I won’t feel a thing.” Sam moves that scalpel blade back and forth like a man possessed. It’s a beautiful thing to see, really.

I’ve got nothing to add to this picture — I just want you all to take in the majesty of granulating tissue festering with pus one more time.

Samwell has successfully removed the first section of skin in full. Just another 300 or so to go!

The scene ends with a head-fake shot of Hot Pie’s hot pie, because if there’s one thing doctors love, it’s conflating diseases with food metaphors. No, really — in dermatology alone we describe the vesicles in eczema as “tapioca-like,” and the crusts in impetigo as “honey-colored,” among many other examples. Because working your hands back and forth on a scalpel blade like it’s a Stradivarius works up a hell of an appetite.

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With essentially no experience whatsoever, Samwell Tarly has resurrected a long-abandoned surgical procedure, and done so with a technical expertise that an archmaester would envy. If Jorah survives — and let’s be real, if he doesn’t, then this was the most pointless scene in the entire series — lead authorship on a cover article in the JWAD (Journal of the Westerosi Academy of Dermatology) is Samwell’s for the taking. If the Citadel adheres to the same “publish or perish” edict that plagues academia in our world, Samwell’s career prospects are looking mighty fine at the moment. That’s true even if the procedure leaves Jorah permanently disfigured, with a body only a Mother of Dragons could love (possibly the one in Westeros, definitely the one at The Ringer.)

So I’d say just give Samwell his chain already, except — let’s rewind the tape, shall we?

SAMWELL, WHAT ARE YOU DOING?

Dude, your gloved hand was in direct contact with Jorah’s greyscale pus literally a second ago, and you’re putting that glove up to your lips?! Do they not teach germ theory at the Citadel? Even if they don’t, did it ever occur to you that a disease that seems to spread only by physical contact might, you know, spread by physical contact?

Well, maybe your gloves just came really close to your lips without actually touching, in which case you might be OK —

OH FOR R’HLLOR’S SAKE

You had already handed Jorah the flask, then you took it back AND DRANK FROM IT? What is wrong with you? You can’t even feign ignorance and claim you didn’t know greyscale could be spread through a fomite (yeah, it’s a real word, look it up). You knew Shireen Baratheon. You should know that she got greyscale not from direct contact with another infected person, but from a doll that she pressed up to her cheek as a baby. SO WHAT ARE YOU DOING?

And for that matter, why the hell weren’t you wearing a face mask during the procedure? I understand that “sterile protocol” means something different in a world where OSHA is a wildling instead of a government agency, but COME ON.

This egregious lapse in hygiene standards notwithstanding, I fully expect to see Jorah Mormont cured of his condition by the next episode. But if I were Gilly, I wouldn’t be kissing Samwell on the lips anytime soon. No matter, though — Samwell’s still a better dermatologist than those idiots on The Night Of ever were.

Disclosure: HBO is an initial investor in The Ringer.

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