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Picking battles

Flawed heroes on TNT's Monday Mornings

Monday Mornings cast 
April 2013 -- From February to April 2013, TNT broadcast the first and only season of its drama Monday Mornings, which portrayed surgeons at a Portland (Oregon) hospital and in particular the tense "morbidity and mortality" conferences at which they examined their errors. The cable series was created by noted television producer David E. Kelley (responsible for the CBS surgeon show Chicago Hope (1994-2000)) and by surgeon and CNN medical correspondent Sanjay Gupta. The new series was based on Gupta's 2012 novel of the same name. All eight major characters on Monday Mornings were surgeons, and the series glorified their work, even with the focus on errors and the portrayal of a few characters as insensitive, arrogant, or even abusive. The show really cared only about what the surgeons were doing, and only they interacted with patients and families. Nurse characters were unusually scarce. In many scenes, they were not even vague shapes in the background, as you might see on Grey's Anatomy. When nurses did appear, they were anonymous helpers, and it was rare to see their faces, though there was the occasional sound of vital signs being reported. One of the few scenes in which a nurse did briefly assert herself came in the series finale, when a crusty ICU nurse tried to limit the number of the surgeons who could see a sick surgeon colleague. The chief of trauma surgery dismissed the nurse's concerns, reminding her to pick her "battles"--a well-chosen word because she was indeed a "battle"-axe, an unpleasant bureaucrat enforcing hospital rules the show presented as trivial. Gupta Monday Mornings book coverOn the whole, Monday Mornings followed the traditional Hollywood hospital show model in which physicians are the heroes who do everything that matters and nurses are, at most, peripheral subordinates.

A distinctive feature of Monday Mornings was the focus on the morbidity and mortality conferences. (These are also known as "M&M" conferences; note the "M" - "M" element that also appears in the show's name.) That focus in itself would tend to create a physician-centric show, since nurses are still generally not part of those physician conferences, and while some nurses have started to conduct their own M&M reviews, we're guessing few Hollywood producers are dying to dramatize those at this point. Of course, there were plenty of scenes in operating rooms and patient rooms, which led to a lot of physician nursing; in general only physicians spoke with patients or family. But many of the most dramatic scenes came in the M&Ms, which the show presented as being somewhat like a court with a close-to-omniscient inquiring judge--chief of surgery Harding Hooten--and the unfortunate surgeons who had experienced bad outcomes as defendants. The court-like approach, of course, would make sense given producer Kelley's extensive background with legal dramas.

Several examples reveal the show's basic features. Early on, one surgeon character failed to do sufficient examination of a patient, resulting in the patient's death. The surgeon was nicknamed 007 ("license to kill," ha ha) and apparently had his privileges revoked. Even admired surgeons made big mistakes. There is certainly value in suggesting the potential drawbacks to physician arrogance, over-confidence, and undue power, but unfortunately, many of the show's scenes celebrated those same qualities. One star neurosurgeon seemed to be a version of Greg House--brilliant, devastatingly blunt, even rude, with only one apparent limitation--in his case, an incomplete knowledge of English owing to his foreign birth. In real life such an insensitive person would be very difficult to work with and therefore endanger lives, whatever his technical skills. But the show saw him as a powerful virtuoso entitled to deference--except from the even more brilliant Hooten, whose abusive approach was itself glorified.

Monday MorningsIn the show's finale, nursing was notable both in its absence and its flawed presence. In one scene, a patient complained to a surgeon character that he'd been waiting in the emergency department (ED) waiting room for two hours. She assured him that someone would be with him as soon as possible. Of course, the chance that a surgeon would be having this interaction is remote; in real life, nurses run ED triage and handle these issues. In a later scene, the chief of surgery called a 10 p.m. M&M while a fellow surgeon lay near death, following an operation. The idea was that the surgeons had to occupy themselves with something, because there was nothing to be done except wait to see how the patient did. This is a common theme on television:  If physicians aren't doing anything, then nothing is being done. Of course, at these times expert nursing care is making the difference between life and death. But here it seemed the only thing happening was waiting.

Nurse RatchedBut wait! When the sick surgeon suddenly regained consciousness, the other surgeons rushed to the ICU, only to be told by some pesky ICU nurse named Gladys that the patient was limited to two visitors at a time! Can you imagine? A nurse! The trauma chief casually but authoritatively overruled Gladys, telling her she had to pick her "battles." And in fact, in this scene Gladys was the embodiment of the evolved Hollywood battle-axe, who may not be a Nurse Ratched-like sociopath, but simply a bitter, myopic enforcer of hospital rules that are seen as trivial, a minor dramatic foil for the physician heroes. In such scenes, there is often no hint of why such rules exist (i.e., to protect patients). And in this scene, with that silly nurse out of the way, the surgeons all gathered round their revived colleague--heartwarming!

Sadly, Monday Mornings itself did not make such a recovery. We just hope some other Hollywood product can carry on the show's work to introduce the public to the little-known activities of surgeons, even if that does mean nursing gets a bit less attention.

 

 

 

 

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