"Hell of a doctor"
Nurse on The Glades is dying to get back to medical school
August 2013 -- The fourth and final season of TNT's summer drama The Glades traced the ongoing efforts of the able nurse Callie Cargill to become a physician. Callie accepted the marriage proposal of the police detective character Jim Longworth and moved back to the Florida town where Jim worked. That meant leaving Atlanta, where she had been attending medical school! (and practicing as a nurse, ho hum). The show suggested that while in Atlanta, Callie had been supervised by a physician, who became a good friend. Back in Florida, Callie planned to defray wedding costs not only by working at her old nursing job--which she supposedly got back based on a reference from the Atlanta physician--but also by doing a temporary research fellowship with a senior orthopedic surgeon. Initially contemptuous, this surgeon warmed to Callie and asserted more than once that she'd be a "hell of a doctor." And when the surgeon died suddenly, he left her enough money to finish medical school! Callie was probably the most significant wannabe-physician character on U.S. television since NBC's ER. Dell from ABC's Private Practice was also notable, but he only announced his medical school plans in his last couple episodes, whereas Callie was on an epic, series-long journey from nursing to the promised land of medicine. Such plotlines suggest to viewers, correctly, that nurses can be smart and skilled. But their overriding message is that if nurses have those qualities, they want to and should become physicians, which is false and damaging. In fact, nurses are perhaps 100 times more likely to pursue graduate education in nursing, usually to become advanced practice nurses. Of course, the nurse-to-physician transition on Hollywood shows is always cause for undiluted celebration; no one suggests that the character might do as much good as a nurse. And with the cancellation of The Glades soon after the final 2013 episode, nothing can be done about Callie's long march toward medicine or the show's suggestions that nurses report to physicians.
Nurses manage hospital nurses...really
As the fourth season begins, we come to understand that in Atlanta, Callie was something of a superstar nurse, and apparently a nurse manager, even as she continued her medical school training, which is now in its third year. Her Atlanta physician friend Miranda Buckley is distraught at Callie's return to Florida, but at least Miranda is able to help Callie get her old emergency department nursing job in the Sunshine State back. That seems to be because the physician who is in charge of hiring nurses at the Florida hospital got a reference from Miranda. But that is absurd, since nurses hire and manage hospital nurses, and physicians have nothing to do with it. Why does the entertainment media continue to tell people that physicians manage hospital nurses? Could it be because media creators simply rely on what they have seen in other media, which has long presented the same specific misconception about nurse-physician relations, along with the sense that physicians are and should be in charge of all health care?
Dying to get back to medical school
Early episodes establish the dynamic between Callie and the prominent but crusty senior surgeon Ted Hardy. In the June 10 episode ("Killer Barbecue"), we learn that Callie plans to help pay for her wedding expenses--and in particular, for an expensive wedding dress--in part through a short-term orthopedic fellowship in which she will help Hardy do some research. Although Callie is bright and conscientious, Hardy is abusive. When Callie pushes back, Hardy simply fires her, telling her she's the worst nurse he ever hired. Callie gives it right back to him. She not only points out Hardy's boorish behavior but also takes the opportunity to criticize the way he is conducting his study, explaining her views in a way that reflects technical knowledge and seems persuasive. The problem here, as with most scenes in which wannabe-physician nurses display skill and toughness, is which profession gets the credit. Is Callie so cool because she's a skilled nurse, or because she is a medical student, destined to be a physician? Later, when Hardy sort of apologizes and persuades her to return, he notes that she's the only nurse he ever fired in 40 years who didn't cry. Great. And let us guess--she's also the only one of those nurses who was a medical student. By the next episode ("Magic Longworth," airing on June 17), Hardy seems to like Callie's work so much that he wants her to finish medical school. He tells detective Jim that she will make "a hell of a doctor." For her part, Callie assures Hardy that she's "dying" to get back to medical school. No doubt that is because being a nurse is so dull and limiting.
The remaining plotlines with Hardy focus on the care of a professional basketball star, Darius Locke. In the July 1 episode ("Glade-iators!"), Hardy asks Callie to do a "house call" for him and see Locke in Miami. There, Locke persuades Callie to give him a cortisone shot. She displays expertise at that, and even seems more careful than Hardy apparently was about the risk of fluoroscopy. But Callie later learns that Locke has lied to her about how many shots he's already had, which puts him at risk of dangerous side effects. Callie tries to get Locke to allow her to speak with his team physician, telling him he's endangering his health. But he ignores her and continues to play extensively.
Not surprisingly, in the July 15 episode ("Three's Company") Locke calls Callie in a lot of pain--he has a joint infection. Callie returns to Miami and helps him. Locke then tells her his whole medical history, apparently as a way to bring her within the scope of patient confidentiality rules, then bars her from telling anyone about it. By the August 5 episode ("Gallerinas"), Hardy has found out about this, and he chastises Callie for giving the cortisone injection too soon. Callie notes that she did not have access to all Locke's files at the time. Hardy responds that Callie's field is in the emergency department (oh, right, she's a nurse), and yet, she can't spot a dope-seeking addict? She says it won't happen again. Later, Callie's son, a basketball fan, informs her that Locke has collapsed during practice and has been benched for the rest of season; his career is probably over. Callie goes back to Hardy to apologize again, but he tells her that Darius Locke is an idiot and "there is no shot for stupid, so stop beating yourself up." Hardy also tells her that her six-week fellowship is over, noting that they are really in different fields, and there is nothing more he can teach her. But there is more for her to learn, he says, so she should go learn it. She leaves, considering this but apparently not convinced.
In the August 12 episode ("Civil War"), Callie returns to the hospital to persuade Hardy that it was arbitrary for him to end the fellowship; she plans to argue that she overhauled and modernized his study and so she should follow through. But she finds Hardy dead on the floor of his office, seemingly the victim of a heart attack. And who does she meet at the service but Darius Locke! Locke honors Hardy, who he says saved his professional life more than once, and Locke also admits that Callie was right about the cortisone and he should have quit. Locke says Hardy told him Callie was "one of the good ones" and that she was "gonna make a hell of a doctor." Later, when Callie stops by Hardy's office to drop off some keys, a woman there tells her that Hardy actually owned the whole hospital and several others, which Callie had not known. And before long Hardy's attorney calls Callie to tell her that Hardy, evidently a loner, left her a lot of money so she could finish medical school.
On the whole, the Hardy plotlines reinforce the idea that able nurses should and do become physicians as their one pathway up and out of nursing. Of course, Callie does associate nursing with strength and clinical expertise to some extent. But there is no question here that Callie's talents are not fully utilized as a nurse, and the important thing is finding a way for her to leave nursing and become a physician.
Several other plotlines during the show's final summer have similar underlying themes. In the June 24 episode ("Apocalypse Now"), we briefly see Callie practicing nursing at the hospital. She seems to play a fairly autonomous role in managing an outbreak of some mysterious infection relevant to one of Jim's cases, and she displays some apparent knowledge of drug abuse. But as always, which profession will get credit?
And the final two episodes manage to underline how skilled Callie is while denigrating nursing. In the August 19 episode ("Happy Trails"), as her wedding approaches, a shady couple from Callie's past, Diane and Rich, seek her help; Callie appears to know them because of her criminal ex-husband. Rich has been wounded, supposedly by some "branches," but obviously it is from some weapon, apparently a knife. Callie says that Rich should go to the emergency department because "he needs a doctor." But they clearly want to avoid that, presumably because the wound is the result of some criminal activity. Callie agrees to help and later seems to have patched Rich up. She says he's lucky the wound was mostly superficial--a few centimeters to the left and one of those "branches" would have punctured his lung. Callie gives Diane instructions on how to clean the wound and change Rich's bandage, and advises that he should stay off his feet for a week.
Not surprisingly, Diane and Rich don't exactly follow those instructions, and Diane soon calls Callie in distress. Callie agrees to meet them at the hospital, where a confident Callie tells the emergency department staff about Rich's new condition: "He has an abdominal perforation about 2-3 cm deep, he's having severe chest pain and difficult breathing and he needs to be prepped for surgery." She tells Diane that Rich had a superficial wound, but now, because he did not take it easy, he needs surgery. Later, we see Callie talking to a surgeon. Then she tells Diane that Rich had a "pneumothorax . . . overexertion caused a small tear in his wound which allowed air to get into his pleural cavity . . . " Diane is confused; Callie assures her that Jim will be fine. Nurse Callie, with all this "medical" knowledge she is getting, is already forgetting how to talk to real people!
Damaging messages about nursing emerge even from the wedding plotline, which features Callie's physician friend Miranda. At one point in the August 26 finale ("Tin Cup"), Callie introduces Miranda as her "supervisor from Atlanta General"--which clearly sends the message that nurses report to physicians. The show did suggest that Callie herself was a manager early in the season, but maybe the idea is that nurses can have some authority, but they all ultimately report to physicians. And the "supervisor" line is consistent with the earlier plotline in which Miranda apparently gave Callie a reference to help her get her old Florida nursing job back.
The Glades did feature an intelligent, strong, and capable nurse. But that seemingly positive feature was undermined by the show's reinforcement of the wannabe physician stereotype, its damaging messages about nursing autonomy, and the likely assignment of credit for many if not all of Callie's skills to her status as a medical student. We won't miss the show.