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The baby man

September 18, 2005 -- Tonight's episode of Lifetime's "Strong Medicine" included two commendable subplots recognizing the autonomy and skill of hunky advanced practice nurse Peter Riggs. Peter got fed up with seeing yet another poor young mother getting inadequate support from her baby's gangbanging father, so he set up a "baby boot camp" for those fathers, which he ran with considerable skill. The episode also briefly highlighted Peter's skills as a midwife, setting him up in competition with surgeon Dylan West in caring for their pregnant colleague, physician Lu Delgado. But most of the episode offered the usual portrait of commanding physicians providing all important care. The anonymous nurses who did appear accepted their "orders" without comment, never speaking to patients or having an extended interaction with the physicians or other nurses. The episode, "It Takes a Clinic," was written by Darin Goldberg and Shelley Meals.

In the "baby boot camp" plot, we first see Peter (above) with a patient at the clinic that he and Lu staff at a Philadelphia hospital. He tells this young mother that she is pregnant again, which she clearly does not want. Peter mentions the birth control pills he got for her, but she says they dried up her milk and she can't afford formula. She also mentions that the baby's father Ysidro doesn't give her much support, that he's clueless with the baby, and that "he's still bangin' anyway." Peter says that he hears "a version of that story every week," but adds: "Maybe there is something I can do." That something is to show up where Ysidro and his crew are playing basketball. They greet Peter as "the baby man." He tells them about a "new program" he's starting at the clinic, "a class where guys can learn about being dads," a "baby boot camp" for "fatherhood skills." They resist, but Peter prevails by winning a bet that he can sink the outside shot one of them just made.

At the clinic, where the gang members actually do show up, Peter starts talking about the role of fathers in children's lives. Members of a rival gang arrive for the camp and tensions flare, but Peter calms them, saying the clinic is neutral territory. Then he pulls back a curtain at one end of the room, and behind it are the gang members' girlfriends and babies, who have maintained total silence this whole time! The women gleefully dump the kids with their men and take off. The men are aghast, but Peter says the best way to get comfortable with your kids is to spend some time with them. He starts coaching them through diaper changing and other basic baby care and development issues. Some tensions remain, but the babies are having an effect. After one man starts playing with the baby of a rival gang member and they square off, another guy gets mad because he just got his baby to sleep! Peter explains what can be done to soothe babies, such as holding them close so they feel the rhythm of your heart, getting them in motion, and so on. Later, two men from the rival gangs challenge each other to a diaper changing race. Peter has the call. And lest anyone think all Peter's baby expertise is somehow wimpy, the episode makes clear that Peter's girlfriend, physician Kayla, finds it very attractive.

Never mind the truckload of improbabilities. This is an example of a nurse actually pulling off a promising public health measure without any suggestion that a physician was responsible, something of a minor miracle for U.S. television. Peter shows considerable initiative, expertise, and interpersonal skill. And he is not doing so in some swaggering ED environment, but in infant care. This suggests not only that men can be nurses, and that nurses can play a key role in health care generally. It says that men can be good nurses even in areas more associated with women, without sacrificing their masculinity.

The other Peter subplot concerns Lu's pregnancy. She has been doing frequent ultrasounds on herself. Peter discovers this and takes over one, assuring her that everything looks fine. Later, though, Lu (right) has some cramping while arguing with surgeon Dylan (far right) about whether his patient, the state's Governor, will commute the death sentence imposed on a mentally disabled patient of Lu's. This time Dylan checks her out and finds all is well, but he urges her to relax. Still later, Peter and Dylan run into each other. First the show establishes how different these two are--conventional guy Dylan says something about the recent Eagles game, alternative guy Peter was too busy with his yoga class to notice it. Receptionist Lana says Lu is doing yet another ultrasound, and both men are on it. Lu says she's had some spotting. Peter and Dylan start arguing over who's her main OB provider. Dylan says he did an ultrasound and he's the OB. Peter says he did one too, and he has delivered a lot more babies. Dylan actually says: "Give me a number." Lu scolds them, and they both confirm the baby looks fine. Later, Lu calls all the major characters together. She has devised a division of labor, and the upshot is that Peter will do any more ultrasounds she needs, and Dylan will do any C-section needed. Left unspecified is who will do the delivery if no C-section is needed.

Again, we noted the absurdities, including that a surgeon would be a viable alternative OB choice to an experienced nurse-midwife. But again, this is an apparent effort to show that Peter has some independent health care skill. He knows how to assess fetal health, and he has delivered a lot of babies, presumably with success. And although he may not follow football, he can be just as myopically competitive as any other red-blooded man.

We'd love to say that these two subplots make the episode a great one for nursing, but sadly, most of the episode is true to the show's overall depiction of the profession. The key plots involve a problem with the Governor's brain that is causing seizures, the related fate of Lu's mentally disabled patient, and efforts to reattach the hand of a promising young pianist who has been in an accident. These do not involve Peter, and in them, the physicians provide all significant care. Silent nurses accept "orders," often to do things that real nurses would already be doing before physicians could request them. On a few occasions, the nurses briefly report vital signs. But the physicians handle all patient interactions, all patient advocacy and education. Paramedics hand off patients to the physicians alone.

The obvious way to reconcile the disparity between this portrayal and the one of Peter would be to conclude that advanced practice nurses are real professionals with some autonomy, but other nurses remain deferential, marginally skilled physician assistants. Nurses can engage in some "strong medicine," the show seems to be saying, but only to the extent they do things that have traditionally been the province of physicians. It's hard to play a significant role in direct patient care when you don't even speak to patients.

 

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