Plot devices in scrubs
December 11, 2005 -- The last two episodes of ABC's "Grey's Anatomy" are notable for more of the show's now-familiar explicit expressions of contempt for nurses (e.g., "skanky syph nurse"). But they also illustrate how nurse characters serve as convenient plot devices for the show. Nurses are vehicles through which the show's pretty physician heroes confront failure, fate, infidelity, class differences, and, for the women, latent fears about female subservience and their own sexual virtue. In fairness, several scenes in the December 4 episode, Mark Wilding's "Owner of a Lonely Heart" (20.75 million viewers), make a stab at "ER"-style handmaiden portrayals, which would actually be a step up. In these, nurses are minimally skilled subordinates who may detect basic changes in patient conditions, and in one case even predict that a specific treatment will not work. But they are helpless to address serious problems, and they look to the physicians--interns, no less--for all care decisions that matter. And with tonight's episode, Krista Vernoff's "Grandma Got Run Over by a Reindeer," it's back to the physician nursing, as the physician characters do all monitoring, all patient interactions, and all key procedures, including defibrillation. The nurses do seem up to catching vomit, though, so that's something.
These two episodes offer more of the show's blatant insults to nursing. Given the large number of vicious anti-nurse slurs since "Grey's Anatomy" began, we are struggling not to say they reflect outright hatred. Most of the venom here centers on the fury of pretty intern Izzie because the object of her affection, pretty intern Alex, had call room sex with less attractive nurse Olivia. The sympathy of Izzie's intern friends is limited, because Izzie and Alex had dated but were not really an item, and everyone knows Alex is kind of a jerk. Alex wants to talk, but Izzie snaps that he's "too busy screwing nurses to talk, just get out." At another point, pretty intern Cristina marvels that "hell hath no fury like a girl whose non-boyfriend screws a nurse." Izzie also accuses Alex of having cheated on her with the "skanky syph nurse," a reference to the fact that Alex had previously given Olivia syphilis, which Olivia had later passed on to intern George. Olivia apparently did not know that Alex and Izzie were sort of involved, and she is very apologetic to Izzie. In response, Izzie projects seething contempt.
The fears of nurse-based sexual degradation, and even of a kind of class miscegenation, in all this are hard to avoid. Alex has not just cheated on Izzie, he has cheated on her with a nurse, the low-rent embodiment of everything a smart, ambitious, attractive modern woman cannot stand and will do anything to avoid. It's a betrayal of Izzie's entire worldview, which seems to revolve around a physician master class that has no serious dealings with the unworthy, sexually degraded rabble. Let's face it: some people just don't belong. And we need not worry about being fair to them. Olivia is a "skanky syph nurse" even though it was actually Alex who gave her syphilis. And although we know that Olivia did sleep with two interns, the show's star, pretty intern Meredith, has apparently been getting drunk and sleeping with a different guy every night since her breakup with pretty attending Derek. In fairness, Izzie does call attention to this in a moment of anger. However, no one uses the expression "skanky syph doc." And even if someone did, physicians do not share nurses' history of naughty nurse stereotyping. Indeed, this is no doubt part of Izzie's concern. Alex's dalliance with Olivia indirectly associates Izzie herself with nursing, in all its low-class skankiness. Of course, Izzie's moral superiority does not stop her from bragging about how great she is in bed while fuming about Olivia. Lest anyone think these skanks are better than she is at anything.
But that is not the only example of explicit contempt for nursing on display here. In the December 11 episode, the interns take turns helping the much-maligned Alex study to retake the clinical part of his boards, which he failed. Tough intern Cristina, meeting some resistance to her efforts to help Alex, gives him this priceless message:
Look, evil spawn, you can nurse your pride--the key word being "nurse"--or you can pass your test and be a doctor.
This comment, like every other anti-nurse slur on the show, goes completely unrebutted. It means that nursing is a job for those who can't cut it as physicians, which is incorrect and, of course, grossly offensive. The comment also suggests that if Alex fails his exam, he will automatically be qualified to be a nurse. In fact, Alex would only be qualified to apply to nursing school. If he got in, he would have to undergo years of college-level theoretical and clinical science training, much of which would be unfamiliar to him, and then he would have to pass the nursing boards. It is not clear that Alex or any intern character on this show could become a nurse, especially given their level of social and emotional immaturity, though the show does have them do a huge amount what we call physician nursing.
As always, the show's nine physician characters spend a good deal of time on tasks that nurses do in real life; presumably sticking to the real physician role would not be compelling enough. Thus, one priceless scene, nine hours after a quintuplet birth, features each of the five major intern characters sitting in the NICU keeping watch over his or her own quint, with no nurses in sight. At one point, Alex has to leave for a while, so he asks another intern to make sure his quint's vitals remain stable. Of course, NICU nurses monitor real NICU patients. The real NICU is a very nurse-focused environment, and no intern--certainly not a surgical intern--would have a leading role in NICU monitoring or care. Elsewhere in the episodes, the physician characters conduct most of the patient monitoring, initiate all care plans, including co-bedding for the quints, and provide all emotional support, including addressing the baby blues of the quints' mother. The nurses who do appear almost never address patients. Perhaps that would be presumptuous with physicians in the hospital. The show could also have provided the quints with much better care by using kangaroo care. Of course, nurses take the leading role in researching and implementing such cutting edge care, so it is unlikely the show would know much about this. Instead, "Grey's Anatomy" has Meredith explicitly telling the new mother that she can't hold her own baby, when in fact that might be precisely what will save her life.
Another theme is that the physicians have all responsibility for patient outcomes. One subplot involves a patient Alex supposedly "killed" when he "told a nurse" (Olivia) "to administer an incorrect dosage of hypertonic saline," thus dehydrating the patient's brain. Alex is wracked with guilt, and several scenes explore it, hammering away at the idea that physician errors kill. No one suggests that Olivia shares responsibility, perhaps because the show is not aware that nurses have independent legal and ethical duties to check the appropriateness of unfamiliar care plans, which Alex's clearly was. In the real world, nurses save countless lives by catching such medication errors.
In other scene, an attending assigns Izzie to stay with a failing quint all night to give her a lesson in keeping emotional distance from patients. Izzie and a nameless nurse work on the patient, but the patient ultimately dies while the exhausted Izzie is sleeping in the NICU. Izzie later sums up her anguish: "I killed her." The attending assures her the quint would have died regardless because of structural abnormalities in the heart, but the point is made again: physicians deserve sole credit for patient outcomes, because even if nurses are present, only physician actions matter. That is a very damaging misrepresentation of the central, pivotal role nurses play in keeping patients alive, especially in intensive care units.
Nurses in these episodes range from petulant assistants with basic knowledge to helpless ninnies. One scene has Olivia trying and failing to apply leeches to a patient's face. She confesses to the patient and intern George that she "should be better" at it, but she gets "a little squeamish" around them. Later, she calls for help again, noting that the leeches really freak her out. George, with his vast experience, has no problems. Of course, a real hospital nurse would probably not last long if he or she was this "squeamish."
On the somewhat better end of the range, the December 4 episode included a few scenes that reminded us somewhat of the traditional "ER" model of nursing depictions. In these, nurses are skilled, if limited, assistants to the physicians who provide important care. The scenes suggest that the nurses have some basic knowledge of care (they might report a vital sign), and that they can detect obvious changes in conditions ("she's not breathing"), and perform some basic procedures, like bagging a patient or pushing a drug. Nurses might even have an idea about whether a particular treatment is likely to be effective, as the nurse helping Izzie in the NICU does. That's about as good as it gets here.
However, the nurses are essentially helpless in the face of major problems, and must await physician commands even for the most common actions, like turning up the oxygen. At times even obvious conditions elude the nurses. In one scene, an older nurse thinks a patient is seizing; it takes intern Cristina to see that the patient is in fact choking on a light bulb. The common theme, one we've seen before on the show, is the nurses freezing in such situations and asking the intern something to the effect of, "what do you want me to do?" Naturally, the stressed out, uncertain interns are impatient, and the nurses' comments are not especially helpful in substance or tone. As in the past, the nurses--who are often hostile, if not crone-like--are more aligned with the problem the interns face than any solution to it. The interns are full-blown humans who feel for their patients. The nurses are plot devices who have never given any sign of being capable of such a connection. In any case, these unusual suggestions that nurses do have some small substantive role in care had disappeared by the December 11 episode, in which physicians decided and did everything pretty much all by themselves.
On the whole, what's likely to stick with viewers is not the marginal, vaguely adversarial role of the nameless nurses in these few scenes, but the specific anti-nurse slurs of show heroes Cristina and Izzie. Visceral contempt has a way of staying with you.