Changing how the world thinks about nursing

Join our Facebook group

An A+ in Getting the Doctor

July 31, 2005 -- In the episode of HBO's "Six Feet Under" first aired tonight, Nancy Oliver's "Ecotone," the sudden illness of main character Nate takes his family and friends to a hospital, where they interact with nurses and physicians. These health workers are certainly not one-dimensional. But they do conform to the prevailing Hollywood belief that nurses are handmaidens, at times disagreeably petty ones, who assist the smart physicians who provide all important care. The episode suggests that when it comes to an understanding of nursing, dramatic sophistication doesn't count for much.

In the episode, Nate Fisher is taken to an LA area hospital after collapsing from what turns out to have been an arteriovenous malformation, which caused a brain hemorrhage. Nate has an operation to stop the bleeding, though he remains in a coma for much of the episode. Meanwhile, his family and friends gather, including Brenda, Nate's pregnant wife, and Maggie, with whom Nate had just had sex when he collapsed. The family deals with two physicians prior to Nate's operation, including a neurosurgeon who tells them what they might expect. She also appears afterwards to answer questions, noting that it could be weeks before Nate emerges from his coma. Both physicians are polite, knowledgeable and reasonably sensitive, though of course they cannot provide the reassurance the family wants. Maggie, one of the first to arrive, also speaks briefly with a woman in scrubs at what seems to be triage, a receiving station adjoining the ED waiting area. This apparent nurse asks the upset Maggie to fill out forms asking about Nate's health and insurance, none of which Maggie knows. The nurse helpfully suggests that Maggie look in Nate's wallet.

The next morning, with Nate on a med-surg floor and only Brenda present, Nate suddenly wakes up. Brenda calls for the nearby nurse. The nurse sees Nate and responds in the classic Hollywood manner: "I'll go get the doctor!" No smile, no support, no assessment, no patient interaction; she pretty much flees the room. Literally one minute later, the nurse reappears to abruptly kick Brenda out so they can run some "tests," though she does move to help by picking up Brenda's purse, without asking. On their way out of the room, the nurse calls to Nate's elderly roommate to get out of the bathroom and back in his bed, as a sheepdog might bark at an errant member of the flock. This is inexplicable, since the patient has been in there only since the start of the scene, perhaps two to three minutes, and there has been no sign of distress. Later, a third physician stops by to follow up for his neurosurgeon colleague, who has left. This physician is obviously just becoming familiar with Nate's case, and he encounters some impatience from the family when he tells them things they already know about the diagnosis. At the end of the episode, once the characters (and the viewers) have gotten used to Nate's hopeful prognosis, he dies, after appearing to share a final dream with his brother David.

Obviously, the episode's depiction of the health workers is more nuanced than "physicians good, nurses bad." The third physician seems to represent the revolving door quality of much modern care, and the triage nurse is supportive of the upset Maggie as she struggles with the forms.

But the episode adheres to nurse-physician stereotypes in key ways. The physicians have all the knowledge, and they provide all the care that matters. The nurses are there to see that forms are filled out, to push people in and out of rooms, and to run for a physician when something happens that calls for a real professional--a grotesque distortion that we have seen time and again from recent Hollywood shows. Of course, nurses do alert other health professionals when necessary. But a real nurse seeing a patient awake from a post-op coma would likely assess the patient's condition in depth, and notify other professionals right away only if there were a clear need for their immediate intervention, which was not the case here. In addition, the apparent triage nurse would likely have been far more involved in getting vital health information from the family, and not in getting insurance data. Here, only the physicians have meaningful interactions about Nate's health history. No nurse displays real knowledge or expertise. They exist to assist. And though no health worker provides much emotional support here, the post-op nurse's conduct in pushing Brenda out right after her husband has emerged from a coma and inexplicably kicking the elderly patient out of the bathroom are clear battleaxe touches. (The Brenda action may to some extent reflect the outdated but persistent Hollywood belief that a patient's family must be ejected before any serious health procedure can occur.) Of course, not everything is based on regressive stereotypes: the neurosurgeon is female. In the dress-for-success feminism of modern Hollywood, some women are more equal than others.

"Six Feet Under," which ends next month, revolves around the Fishers' funeral home. Each episode starts with the death of a person for whom the home will ultimately provide services. In this one, a man hiking in the Santa Monica mountains is suddenly mauled by a cougar. Nate, upon hearing about this from funeral home co-owner Rico, notes that the death was a product of the "ecotone," the transitional area in which two different ecosystems overlap, in this case the city and the surrounding mountains. This idea of a transitional zone might also refer to Nate's status in the episode, as he seems to pause between life and death.

But consider the episode as one small part of the health care-media ecotone. That zone might be thought of as the overlap between the real world, in which nurses are highly skilled, educated professionals at the core of modern health care, and too much of the media world, in which nurses pretty much go get the doctor. Nurses aren't the only ones getting mauled in that zone, as recent reports on the deadly effects of the global shortage make clear.

Also see our August 21, 2005 analysis of the "Six Feet Under"'s finale "Everyone's Waiting."

 

‚Äč