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Digging through crap

November 9, 2006 -- Tonight ABC's "Grey's Anatomy" included a plotline in which the "nurse's job" of "dig[ging] through crap" was used relentlessly as a symbol of professional disaster for the show's smart, ambitious surgical interns. Intern Cristina Yang spends most of the episode sifting through the stool of a boy who has swallowed Monopoly pieces. This is presented as a brutal punishment from Cristina's chief resident. Intern Izzie Stevens joins Cristina, in a desperate effort to avoid her own mandatory peer counseling. The plotline equates nursing with disgusting, trivial work that no educated, ambitious person would ever want to do (ewww!). Later, nurse Moe pages Cristina when the boy starts vomiting. Cristina quickly diagnoses a perforated bowel and directs the clueless Moe to page the chief resident. Thus, nurses do alert physicians to obvious changes in patient conditions, so the physicians can give life-saving care. Physicians also provide all other important care on the show, though nurses may be present at the edge of the main action, silently doing some little nurse thing. The episode, Mark Wilding's "Where the Boys Are," was seen by 20.6 million viewers in its initial U.S. airing and millions more around the world.

In the episode, chief resident Miranda Bailey introduces Cristina to Eric, a boy with 21 Monopoly pieces in his belly. He ate them because his older brother would not let him play in a game with the brother's friends. Bailey asks Cristina what she would do. Cristina, somewhat incredulous that Bailey has even involved her in such a case, recommends that they track and inventory the pieces, look at the X-rays, and keep examining the boy's stool. Bailey: "Very good. Enjoy." Cristina, desperate to avoid this disgusting, menial task, responds: "Isn't this more of a nurse's job?" Bailey: "Are you too good to help that boy?" Cristina: "Yesss..." Then, seeing Bailey's face, she changes her answer: "No. Definitely not. I just thought I'd be more help if I was assisting you in a surgery." Bailey tells her that will not happen until Cristina explains why she erased Bailey's name from the board stating who would scrub in for a "humpty dumpty" surgery performed in an earlier episode by attending Preston Burke. Viewers know that Cristina did that to cover the fact that Burke, her boyfriend, still has a hand tremor as a result of a gunshot wound suffered in a prior episode. Cristina has been assisting in his operations to cover this up, and she feels she can't tell Bailey. So she resigns herself to the Monopoly task.

Meanwhile, Izzie is distraught that her all-day peer counseling will be with "heal with love" Sydney, a perky, touchy-feely surgeon none of the central characters likes. Izzie must undergo this counseling because some time ago she induced a critical situation in her boyfriend's health so he could jump ahead on a heart transplant list. He died, and Izzie remains deeply troubled by the situation. Because anything would be better than Sydney, Izzie volunteers to help Cristina, and we see her at work doing so.

Later, Sydney finds Izzie sifting through Eric's stool with Cristina. Sydney is fine with Izzie's work there ("patient care always comes first!"), and she says she'll just wait for Izzie to finish ("then we'll dialogue!"). The two interns continue to, as Izzie says, "dig through crap." But Sydney's cheery patter eventually annoys Cristina so much that she kicks Izzie out, stressing: "This is my crap, Bailey assigned me this crap." After Izzie leaves, Eric mocks Cristina for her poor relations with her colleagues. Cristina reminds him that he's the one who ate all the Monopoly pieces, which wasn't very smart. But this kid's a pistol, and he retorts: "You're fishing through my poop; how smart are you?"

Later, as Cristina is off doing something else, she gets a page back to Eric's room, where he is vomiting into a basin his mother is holding. Cristina addresses Moe, a nurse who occasionally appears on the show: "What the hell happened?" Moe gives his technical nursing assessment: "He was fine one minute, and then he just--" Cristina, who isn't really listening, takes charge. She tells Eric to lie down, feels his belly, and diagnoses the problem in a few seconds: "Abdomen is rigid; there's blood in the vomit, he's perfed, page Bailey." And Moe is gone from the plot, not too aware of what might be up with a vomiting patient, but skilled at getting physicians for other physicians. Of course, Bailey refuses to allow Cristina into the ensuing surgery.

But we're still not done with the stool theme. Later, Izzie finally levels with Sydney: "I would rather sift through feces than talk to you."

Is this coming through loud and clear?

Nursing = Digging through crap = A waste of time for intelligent people with something important to contribute

As in the past, the show equates nursing with punishment, with disgusting work that senior physicians assign to junior ones to teach them a lesson. Such plotlines also suggest that physicians are in charge of nursing work. There is no hint that assessing stool might actually involve a little more than finding Monopoly pieces (nurses can detect clues to various conditions this way), nor that nursing involves anything more intellectually challenging than counting to 21 (on the other hand, with that skill, at least nurses can play blackjack). The scene with Moe is no help to nursing--his ability to assess and react to Eric's perforated bowel is apparently limited to recognizing that vomiting is bad and paging physicians. And neither Moe nor anyone else pursues Eric's psychosocial problems.

Of course, physician characters provide all the psychosocial care we do see, along with all the other parts of nurses' real jobs that viewers would regard as interesting and important. When nurses do appear, they tend to stand by, essentially mute, while the physicians perform surgery, deliver a baby, etc.

The episode follows the basic script "Grey's Anatomy" has laid out for nurses since the beginning. Nursing remains a convenient marker for the grotesque, inconsequential workplace drudgery that smart, empowered modern women have left behind. It's sort of admirable, in a "someone's got to do it" kind of way. But the bottom line is that the self-respecting "Grey's" viewer is, in fact, too good to help that boy.

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