Quacks like you
"The Mindy Project" attacks nursing and midwifery
December 4, 2012 -- Mindy Kaling's new Fox sitcom The Mindy Project, which is set at a small obstetrics practice in New York City, is bad for nursing. Kaling's lookin'-for-love OB-GYN character and the other physicians alone provide skilled care -- by coincidence, Kaling's late mother was an OB-GYN -- while the one minor nurse character Morgan Tookers is a goofy ex-convict. Well-intentioned but ignorant, very odd, and a little scary, Morgan doesn't show much health expertise, and he seems to be based mostly on The Janitor from Scrubs. But wait -- tonight's episode, written by Kaling, also includes a grossly inaccurate attack on midwives! In the main plotline, a holistic midwifery practice led by two New Agey men is "stealing" patients from the traditional OB-GYN practice that Mindy and her two male physician colleagues run. Mindy gets the patients back by telling them that midwives have no significant health training or skill and that only physicians can provide real health care to pregnant women, lies the show presents as hard but inescapable truths. The show's physician characters also caricature the midwives as seductive "charlatans" and "quacks" who are hostile to all "Western medicine," including drugs and vaccines. These seem to be lay midwives, but viewers are likely to apply the show's powerful messages to all midwives (it's not clear if Kaling actually knows that many midwives are nurses with graduate degrees). In fairness, the lead midwife in the episode is a strong, clever character who notes that midwifery predates obstetrics. And we realize that the show mocks everyone for one thing or another; Mindy and her physician colleagues are a bit self-involved and socially maladroit. But the episode never offers any serious criticism of physicians as health providers. And this episode is consistent with the economic and territorial fear some physicians seem to have for advanced practice nurses. The episode may also reflect a reactionary sense that traditional professional and educational hierarchies are under threat. And it is telling that Kaling targets male midwives, even though the vast majority of real midwives are female. Of course, showing that reality might have complicated her gender goals, which involve getting her character the respect of her male physician colleagues. And speaking of reality, in the real world all midwives receive years of health care training. And research shows that the care of certified nurse midwives is at least as good as that of physicians overall. We urge the show to avoid further attacks on nursing and midwifery.
The Mindy Project really is Kaling's show; in addition to writing this episode ("Two to One") and others, she is the show creator and an executive producer. She has stated that the show was inspired in part by her mother's work as an OG-GYN in Boston. At the start of tonight's episode, the Mindy character learns that her practice's senior member, Dr. Shulman, has abruptly retired and left the practice to Mindy and her two male physician colleagues, Danny and Jeremy. Soon after, we see Mindy bantering with a very pregnant patient, asking her not to bring printouts from the website WebMD, saying that it's like asking a restaurant to cook a recipe you brought -- a joke that certainly fits the episode's overall theme of physician territory under threat by pretenders.
Soon, the episode's main plotline becomes clear, as the decent but abrasive Danny and the shallow, egomaniacal Jeremy have a meeting about the practice's future without even inviting Mindy. The practice's attorney says he assumes they will be keeping most or all of the retiring Shulman's patients. But we soon learn that they are in fact losing some of the patients to the Downtown Women's Holistic Birth Center, which is located upstairs in their building.
Denny: Midwives. It's one thing to lose our patients to doctors but to those charlatans? It makes me sick.
Danny instructs an administrator to email all of Shulman's patients and offer them discounts. Mindy argues for individual contacts -- the first hint that she has better interpersonal skills, kind of like, well, a midwife -- but Danny and Jeremy outvote her, certain that, as men, they know better. As the office continues to struggle with what comes to seem like a grave intergalactic midwife threat, the holistic birth center's administrative assistant Diana stops by to ask why the Shulman practice has not been transferring patient files to them as required.The Shulman receptionists tell Diana to get out.
Meanwhile, Danny and Jeremy decide to turn Shulman's former office into a storage area. Mindy says she wants it to become the "prenatal patient resource center" she has been planning, an idea she claims Kelly Ripa has endorsed. But the guys just want her to take her day off -- "best friend day" -- and leave them alone. Nurse Morgan Tookers, who is helping, gently advises Mindy to take the little scale model of the prenatal center with her, because "it's kind of in the way."
Mindy: Et tu, Morgan?
Ah, nurse Morgan. This last exchange tells viewers that Morgan is so lacking in education that he doesn't even get Mindy's reference to Shakespeare's account of Julius Caesar's supposed comment to his betrayer Brutus, a usage so common now that it's a cliché. Morgan was introduced in the October 2 episode, when the physicians decided they had to fire his predecessor, a hostile, drug-abusing, possibly psychotic older woman. Mindy and Danny conducted the hiring. One of the candidates was a clearly competent nurse (right) who had been trained at Johns Hopkins and worked in Iraq; watching Mindy and Danny bicker in the interview, she got up and left, telling them they were wasting her time and that she had seen "child soldiers in Africa with better manners." Amazing -- nurses go to college?! The only problem was that this nurse reacted to Mindy's reference to her good credentials by boasting, without irony, that she "should have been a doctor," a remark no self-respecting nurse would make and one that reinforces the tired wannabe physician stereotype. The last nurse candidate was Morgan, who showed up in a track suit. He admitted that he had spent time in jail for stealing cars, but said he had gotten his "nursing license" and had been straight for years. Of course, getting that license might not have been so easy with a criminal record since ex-convicts are usually precluded from becoming nurses. Anyway, Mindy and Danny saw that the bizarre Morgan wouldn't work out and they told him so. But soon after, it fell to Mindy to actually fire the existing nurse, who reacted by breaking Mindy's nose. Danny and the others tried to calm Mindy, but it was the lingering Morgan who took charge and actually re-set her nose with minimal fuss. So Mindy insisted on hiring him. This one fleeting example of Morgan's practical skill was nice, but it can't begin to redeem the awful remainder of the portrayal, which includes, in the November 20 episode, a joke by Mindy's boyfriend that she should keep her hands off her "male nurse."
In any case, back in the midwife episode, the two midwives from upstairs pay a visit to Mindy's office. The attractive lead midwife, Brendan Deloriay, quickly charms the receptionist, relieving her neck pain by soothing her and then simply lowering her chair. Brendan points out that the human neck has been around much longer than chairs have. When he introduces himself, though, she knows he's the enemy. Brendan introduces his "brother, best friend, business partner, and tennis coach" Duncan, who is checking out a plant that sits on the receptionist's desk.
Duncan: Does this plant have utility or is it strictly decorative?
Morgan: One time I put sunglasses and a hat on it.
Duncan (apparently sincere): That's hilarious.
The receptionist says she thinks they should leave. But she does thank "Dr. Deloriay" for helping with her neck. Just then, Danny surfaces.
Danny: They're not doctors, they're midwives.
Brendan: Oh . . . hello, Danny.
Danny: I prefer if you call me "Dr. Castellano."
Brendan: I've always found "doctor" to be such a formality. It's so distancing.
Danny: You know what, you're right, it is distancing. It's the distance between actual doctors like me and quacks like you and your brother. Isn't that right, Dr. Reed? Dr. Reed?
Brendan: He left. I think he was embarrassed about being a drug dealer.
Danny: Not this again. They're prescriptions.
Brendan: And prescriptions are little pieces of paper one trades in for narcotics. Making this lovely establishment not different from the hacienda of Pablo Escobar.
Danny: Hey pal, I went to Columbia Medical School.
Brendan: I got into Columbia. Didn't go. Walked the campus, got a bad vibe. Did you know that midwifery predates obstetrics by multiple millennia? So I ask you this, Danny: Confucius, the Buddha, Jesus Christ, even Sting himself -- were they birthed by OB-GYNs?
Danny: Shoulda been.
Brendan: Shoulda woulda coulda. Is that . . . doctor terminology? I just don't understand that stuff. By the way, I hear there's a hold-up in transferring some files upstairs to our new clients. But you'll take care of that, right Danny? It's a great place you got here, nice layout. Good to know in case we decide to expand. Duncan, shall we? Toodles.
Morgan (having put the hat and sunglasses on the plant, speaking as the plant): Dr. C! Who were those guys -- they were cool.
Danny: They're midwives, so let's not, they're not cool.
Morgan: They're midwives with attitude.
Danny: All right. Keep up the good work.
Morgan: You keep up your good work! (Danny retreats to his office.) I'm worried about him.
Later, we see a patient apparently explaining to the OB-GYN office staff why she's leaving.
Patient: This country is succumbing to an epidemic of over-medication. That's what the midwives said. Also, they put smooth rocks in their bathroom sink!
Morgan: You want rocks? I'm going to a quarry after work, I'll have rocks comin' out your friggin' eyes --
Jeremy: No! Mrs. DeSouza, could we have but five minutes of your time --
Danny: Legally, we have to give your file back, but I think you're gonna like what we have to say. (And then in his office.) With all due respect, you have no idea how stupid that sounds.
DeSouza: We don't even know what's in these vaccines.
Danny: Excuse me? (After Jeremy intervenes.) I'm not calling you stupid, I'm saying denying your baby Western medicine, that's extremely stupid.
Jeremy tries to charm DeSouza, but that seems to mean bragging that he appeared in some taxicab ads for the practice and then suggesting that they "pop [DeSouza] in those stirrups and take a damn good peek!" She starts to leave. Danny tries to offer her discounts. She's gone.
The staff is worried enough about losing patients to repeatedly text Mindy, who is shopping with her friends. Mindy ignores the texts until it seems that one of her own patients is leaving the practice, at which point she directs that the file not be released to the midwives.
Mindy (to her friends): Some weird half-doctors are trying to patient-jack me.
"Weird half-doctors"?! So, in the same way, would a playwright be a "weird half-screenwriter"? Is this . . . TV writer terminology? We just don't understand that stuff.
Mindy arrives back at the office heads for "the hornet's nest," which means the midwifery practice. The staff follow. Mindy arrives and rings the gong in the holistic waiting room.
Mindy (seeing some of her practice's former patients): Well, well, well. Debbie, Emily, Lauren -- so many familiar faces. (Ringing the gong annoyingly.) Midwives! Midwives!
Brendan: Easy there. That gong was a gift from me to myself after a particularly rough flight.
Mindy: I have a question for you. Who the hell do you think you are?
Brendan: It's a big complex question, but my name is Brendan Deloriay, it's nice to meet -- -
Mindy: I don't think so, pal. I'm not going to fall for that smooth, calm, BS that everyone else seems to fall for. 'Cause guess what? I know your type. Let's say I have a heart attack. How would you handle that? (Turning to Duncan.) Would you, uh, rub eucalyptus leaves all around my chest, huh? Is that what you would do? While your brother over here, he, uh, plays a rain stick or something?
Brendan: Let's leave Duncan out of this. When you have more time, I'd love to tell you what we do, so that you could speak from a place of knowledge, rather than ignorance.
Mindy: I'm sure you'd love to educate me all afternoon, just, over and over, just making me learn about midwifery . . .
Brendan (seductively): I'd love to educate you.
Mindy: Listen up, ladies, I get it. It is very hard not to get seduced by these two. This office is dope. Diana [the administrator] seems really cool, and yeah, I'm gonna say it, these two [midwives], super good-looking, super hot guys. Much better-looking than the two old grizzled beat-up guys that work in our office. And yeah, if you are a healthy, 22-year-old pregnant woman, that baby is gonna slide right out of you, whether it's by us, or whether it's by these two midwives, or with a jittery train conductor during a blizzard. But what if there's complications? If you're middle-aged, you have diabetes, you're obese (pointing at a woman) -- no offense -- all right, then no amount of breathing techniques and scented oils is gonna help you. I am, and these guys [her partners] are. They might not be easy on the eyes, but they're good doctors. Meanwhile, these two [the midwives], they're going to drop you curbside at Columbia Presbyterian on their way to Coachella.
Brendan: We have never been to the Coachella Valley Music and Arts Festival.
Mindy: Tell me this, Deloriays, is it true or is it not true that if your patients have complications, you drop them off with obstetricians like us?
Brendan: Yes, we explain up front to all of our patients that --
Mindy: I'm sorry, your what?
Brendan (brother whispering in his ear): -- to our clients --
Mindy: That's what I thought. All right, ladies. Let's go downstairs, let's set up appointments with some real doctors.
Danny: And in a month or so, we're gonna debut the Shulman & Associates prenatal resource center, Kelly Ripa's a big fan, so we got a lot of big things on the horizon.
Danny tells Mindy that she did a good job and they all prepare to leave. Mindy refuses to give Diana the gong stick back, saying if they steal another patient, she's coming back with it. But Brendan calls Mindy and approaches. He seems to pick an eyelash from under her eye, then hold it before her. He tells her to make a wish, and they blow the eyelash away together. Mindy allows that that was "kinda hot," but she reiterates that there will be "no more stealing patients." Morgan is smiling and tells Duncan it was a pleasure meeting him; Mindy pulls Morgan away with her.
Later, at their office, Danny and Jeremy apologize to Mindy and promise to involve her in future decisions. Morgan calls to them from a little ways off, having just taken their picture.
Morgan: Wow, that is a nice moment. I'm gonna call it, the founding of a new dynasty. I'm gonna sell you guys the prints once I get 'em developed. I'll need a little markup for all my trouble.
The physicians don't really react to this nonsense, but go about their business, Mindy to deliver another baby, the men to assure each other that they are in fact better looking than the midwives.
Roughly 2.7 million viewers saw this unfounded attack on midwives, and although Kaling's show is a sitcom, that will not stop those viewers from internalizing the episode's serious underlying themes. We appreciate that the Brendan character was not an idiot, but instead someone who could banter with the physicians, and he did at least note that midwifery predates obstetrics by thousands of years. But the episode still sends the message that using midwifery today is dangerous. Kaling is not "joking" in telling viewers that midwives are seductive "quacks" and "charlatans" with no health care training who oppose all medication, including vaccines, who would have no idea how to handle complications, and who would just abandon patients to obstetricians if any occurred. Brendan has not gone to Columbia; has he had any health care training at all? Oh, and apparently midwives aren't allowed to call their patients "patients" -- physicians own that term. We are never given any reason to doubt any of this nonsense. On the whole, the episode's vision of midwifery is regressive and ignorant. Of course, we doubt it would bother the American College of Obstetricians and Gynecologists.
Kaling's decision to portray the midwives as male is instructive. Of course, the vast majority of midwives are female, and male midwives are a breed rarely sighted outside of Hollywood shows looking to score empowerment points by having female physicians boss men around. The most prominent examples are Peter Riggs, the hunky nurse midwife in the Lifetime series Strong Medicine (2000-2006), and Dell Parker (below), the nurse who became a midwife on ABC's Private Practice before the show killed him off in 2010, just after he had giddily announced that he had been admitted to medical school. Both of those characters gave the shows' female creators a chance to show expert female physicians exerting power over pretty male nurses, a neat and presumably satisfying reversal of traditional workplace power dynamics. Here, Kaling is taking a somewhat different approach, not having the male midwives in a directly subordinate role, but still exerting power over them -- she has reversed the traditional gender power dynamics, which must feel great, but also completely embraced traditional professional power dynamics, which must also feel great. It's a real win-win, except for the undermining public health part.
In fact, research shows that the care of certified nurse midwives is at least as good as that of physicians, and better in some respects. These midwives have graduate degrees from universities like, well, Columbia, as does Cara Muhlhahn, the New York midwife who appeared in Ricki Lake's powerful 2008 film The Business of Being Born. Contrary to the impression left by this Mindy episode, many nurse midwives deliver in hospitals. Those who perform home births would, as the episode says, take a patient with complications to a hospital, but that is no reason to disregard the benefits of home births. Kaling's speech near the end sets up a false dichotomy, suggesting that pregnant women are either healthy 22-year-olds or high risk, but of course, most pregnant women are in between those extremes. All women and their babies benefit from skilled prenatal, delivery, and antenatal care. In fact, the implication that healthy young pregnant women don't really need any care at all is, well, "extremely stupid."
Outside the prosperous New York environment depicted in this episode, the failure to embrace the benefits of midwifery is a public health tragedy. The data show that other developed nations achieve better outcomes at lower costs than the U.S. does with less interventionist, midwife-centered birth models. Midwives are not trendy fakers that nutty celebrities and pampered Upper West Side liberals are foisting on an unsuspected public. Many home birth advocates argue that using a midwife is actually a healthier, safer option, noting that in recent years hospitals have increasingly performed unnecessary and risky Caesarian sections, whether because of a fear of lawsuits, the convenience of physicians or patients, or the interventionist, profit-driven physician culture dissected in the Business of Being Born.
Kaling and the others responsible for The Mindy Project should reconsider their assumptions about midwives and nursing, and try to make amends for the damage this episode has done. We suggest they include a plotline with a competent nurse midwife who actually knows what she's doing -- yes, how about a strong female nurse, what a kooky idea! As for the Morgan character, it would probably be better if he simply disappeared from the show, since being an idiot is so central to his persona, and his flashes of ability and insight are so rare. We don't really expect that, but we can hope that he might get to provide a little skilled health care from time to time. In these ways, the show might at least take a few baby steps toward a place of knowledge.