Changing how the world thinks about nursing

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And on the eighth day, the Lord Physician created nurses, to clean up the mess

November 15, 2005 -- Both Fox's "House" and ABC's "Grey's Anatomy" have shown utter contempt for nursing. But the two new prime time hits have taken somewhat different approaches. "House" is addicted to physician nursing. Its six physician characters are constantly doing key care tasks that nurses do in real life. The rare nurse characters are silent, barely visible clerks, like wallpaper that assumes human form to move or hold objects. "Grey's Anatomy," with nine physician characters, has at times had nurses utter a minor substantive line. However, it has often insulted nursing directly. Its interns regard the word "nurse" as a slur, and the nurses who do appear tend to be bitter or fawning losers, whose lives revolve around the godlike physicians. But two recent episodes of "House" (Thomas L. Moran's "Daddy's Boy," aired on Nov. 8, 14 million viewers, and Sara Hess's "Spin," aired on Nov. 15, 13 million viewers) prove that the Fox show is more than capable of its own specific anti-nurse slurs. In these, "House"'s brilliant physician heroes suggest that they consider nurses unskilled clean-up staff, "nurse-maids" who are good for handling stool and patients who have fallen down. The money quote? Über-diagnostician and wit Greg House has just temporarily relieved a patient's thymoma with a Tensilon injection, and gone off on a "playing God" riff. When the drug wears off, as expected, the patient falls to the floor. House says this is "exactly why I created nurses," then calls out into the hallway, "clean-up on aisle three!"

See the "Clean Up On Aisle Three" film clip in Quicktime at broadband or dialup speed.

The inclusion of pointed nurse-as-unskilled-menial-worker themes in back-to-back episodes was remarkable. In the November 8 episode, two physicians on House's team are examining a young patient who is having unexplained seizures, and who ultimately turns out to have radiation poisoning. As the physicians speak with the patient, he has stool incontinence due to sphincter paralysis. One physician notes: "We're going to need a nurse." Given everything the show has done to marginalize nurses, we laughed at this uproarious tribute to what nurses are good for. Then the other physician reassures the surprised and embarrassed patient: "It's OK. We'll take care of it." We ? We laughed even harder. But no one on the show did, suggesting that the joke was on us. No one is going to see this scene as a wry criticism of some physicians' reluctance to help with care tasks they view as beneath them, nor of the tendency of some to take credit for the efforts of the rest of the health care team. What "we" have here is more like a solemn endorsement of these practices.

Later in the November 8 episode, the show offers an example of its standard way of endorsing the idea of physician superiority: a put-down from House himself. House intercepts the ambulance crew bringing in the main patient's similarly afflicted friend as soon as they get through the ED entrance. House, who wants to examine an infection nears the friend's groin for clues, commands: "Take off his pants." One of the paramedics says politely: "He's vomited in excess of three units of blood. He needs to be admitted before you--" House knocks him back: "If you wanted to be a doctor, maybe you should have buckled down a little more in high school." The paramedic responds, sneering but impotent: "Bite me." That doesn't exactly disprove House's underlying point about whose mind is functioning at a higher level, though we suppose it is better than the hurt silence with which "ER"'s nurse characters have often responded to physician slurs. But as on "ER," the take-away message will be that House is obnoxious and people don't like it, but there is a harsh, kind of sexy truth in his words. Physicians are academic stars, and by comparison the rest of the health care team are uneducated flunkies. House can't really mock people for being black or female, but class-based slurs are fine. Because the show doesn't care about the paramedic, House pays no dramatic price here. What would we have had the paramedic say in response to House's gratuitous putdown? "And if you wanted emergency care expertise, maybe you should have spent less time consoling your sad little self with obscure diagnostic masturbation, and more on learning to save lives."

But the November 15 episode has far more striking examples of the joking-or-am-I? method of mocking the rest of the health care team. These scenes feature explicit anti-nurse views that the show has never given viewers any real reason to question. This episode focuses on a professional cyclist who collapses during a race. But the main subplot is about House's relationship with old flame Stacy, a lawyer at the hospital who is now married to someone else. House and Stacy's love-hate relationship includes House tormenting her husband, who is recovering from a serious illness. House crashes a group counseling session with the husband. At first House, who uses a cane, seems to make a genuine effort to bond about what it's like to be the needy, disabled man in Stacy's life. But he ends up playing inadequacy mind games with hubby about why Stacy might not stick around. The kicker: "She didn't get married to be a nurse-maid. She wants a man."

The antiquated term "nurse-maid" neatly connects nursing care with maid service, and also suggests that a lawyer could do it, in both cases sending the message that nursing does not require training or skill. It also suggests that this kind of old-time hand-holding would be beneath a smart, ambitious, modern person like Stacy. Of course, in reality nursing requires years of college-level training, and hundreds of thousands of nurses hold graduate degrees in nursing.

Near the end of the episode, House determines what has been causing the cyclist's myasthenia gravis and PRCA: thymoma. House walks into the patient's room and plunges a syringe of Tensilon into his leg. This eases his symptoms for a few minutes, so much so that the patient gets out of bed, while having the following exchange with House:

House:         You are healed. Rise and walk.  

Patient:         Are you insane?

House:          In the Bible. Just say, "Yes, Lord," and start right in on praising.

Patient:         What did you do?

House:          No, "What did you do, Lord. " [Then, seeing the patient collapse on the floor] This is exactly why I created nurses. [Stepping to the doorway and calling down the hall] Clean-up on aisle three!

Yes, we get that House is being facetious, he doesn't literally think he's "God," he's just having fun with the miracle of modern drugs, and celebrating his usual brilliant diagnostic skills, which have proved too much for yet another wily illness. It's even possible that the show's producers are aware of the "God complex," the affliction in which physicians whose work involves life and death, and who enjoy excessive social and economic status, may come to believe they are more than human, and therefore need not play by the rules that bind everyone else.

But House and his colleagues, patients, creators, and audience all really do regard him as something of a flawed demi-god, a world-famous Holmesian curmudgeon who saves lives while shredding every ego and illusion within 10 yards. And this brings us to the Physician-God who created nurses so that they can clean up messes. Since many people do associate nursing with unskilled clean-up work (e.g. bedpans), House's comment allows us to laugh at the poor nurses' icky jobs, while absolving us of any responsibility, because he's just "kidding." What if House had said this is why He created women? Would he still be so endearing and sexy?

Of course, to balance out these slurs, the episodes show nurses as the skilled life-savers they really are, autonomously monitoring and treating patients, providing key psycho-social care, teaching and advocacy. Ha ha--kidding! As usual, on "House" the nurses essentially do not exist. On the rare occasions they appear, they do not speak. Their job is to hand the physicians something, or just stand there.

Oh, but "House," like every other Hollywood show about hospitals or health workers, just "happens" to focus on physicians, so we can't expect it to show nurses or what they do, right? Except that, like the other shows, "House" has plenty of nursing--it just has physicians doing it. The show's physicians do virtually all patient monitoring, all medication administration, all resuscitation, all psycho-social support, all patient advocacy and education. Silent nurses may occasionally appear, in blurry background or at the edge of the frame, but that's it. The result is not that viewers conclude that this show just happens to focus on physicians, while nursing is a whole other interesting world that just happens never to appear on their TV screens. Viewers conclude that physicians provide all important care, and that nurses are mute, subordinate clean-up crew whose unskilled work is of no interest whatsoever. Bright, ambitious people don't get married to be a "nurse-maid." Ha ha--joking! No, really. No, joking!

This relentless, persuasive degradation of the nursing image is a major factor in the nursing crisis that continues to claim lives worldwide. Of course, real physicians are not qualified to do a great deal of what nurses do to save lives and improve outcomes. So if hospitals really worked the way "House" pretends they do, there would be countless unnecessary fatalities, including in the Hollywood area. Clean-up on aisle three!

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