Changing how the world thinks about nursing

Join our Facebook group

Comic relief

NY Med returns with more heroic surgeons, plus nurses with zany patients

nurseAugust 2014 -- This summer ABC aired the second season of Terence Wrong's documentary series NY Med, which focuses mainly on surgeons and other physicians at several New York City area hospitals. As in the first season in 2012, these eight new episodes mostly follow heroic surgeons and their patients over the course of extended treatment processes. Once again, TV personality and heart surgeon Mehmet Oz lends his star quality to several episodes. The series also features some emergency department (ED) physicians in New York and Newark, showing them to be expert and commanding. Last and least, as in 2012, the series includes occasional segments with three veteran ED nurses. They do, rarely, get chances to display health knowledge and skill, although their interludes are really more about the zany patients they encounter. This time, two of the nurses get a bit more attention when they temporarily become patients themselves, because of a heart condition and a car accident. The third nurse gets fired early on as a result of a social media fail, only to re-appear undaunted later at a different hospital. In contrast to Showtime's Nurse Jackie, a drama that depicts a fictional New York ED, Terence Wrong rarely focuses on nurses and physicians collaborating or interacting about the same patient. It is as if the brief nurse segments are light comic relief that he would not want to clutter the serious, in-depth surgical stories; those tend to ignore any nursing role in the care of profiled patients. nurseIf Mr. Wrong makes more shows like this in the future--and he has been at it since Hopkins 24/7 in 2000--we urge him to convey more of the life-saving roles that nurses play in critical care.

I am the conductor of the trauma bay

A powerful trio confronts some shenanigans
 

I am the conductor of the trauma bay

Although we discuss NY Med's nurse-focused segments in some detail below, we should first emphasize again that the vast majority of the show is devoted to physicians and their care of patients, and so we will make a few observations about that. In every episode, the major plotlines follow surgical cases, with surgeons at various levels of seniority narrating the case at hand and discussing their work, along with scenes featuring the patients and their families, both in and out of the clinical setting. Other segments do a streamlined version of that with ED physicians, including trauma surgeons; of course, they do not usually see patients for the kind of extended emotional journey in which Wrong and his colleagues seem most interested. In all these segments, it's striking how rarely nurses appear. When they do, they seem to have roughly the same status as nurses on shows like ABC's Grey's Anatomy typically do--they are at the periphery, they do not generally speak, at times they seem to be absorbing commands, but whatever they are doing, it is of no real interest to the physicians, the patients, or the show. Of course, it's true that the physicians do not appear much in the few nurse-focused segments, but those segments are so minimal that it means little. Indeed, that reverse exclusion merely underlines the curious failure to show much collaborative care, as discussed above.

Even in emergency scenes, the nurses are mostly quiet or absent, whether because they were shooed away by producers or physicians, or because they simply chose on their own to keep a low profile, perhaps feeling unworthy of attention when the physician stars are present. And if anyone doubts the physicians' place in the scheme of clinical matters, just ask them. Marin Alsop and the Baltimore Symphony OrchestraAs one trauma surgeon at Newark's University Hospital modestly announces in the June 26 episode: "I am the conductor of the trauma bay." That is a dangerously misleading description of hospital care--physicians may "run the code," but that does not mean they are in charge of everything, as a music director is. Sadly, the show seems to take this kind of swagger at face value.

The series also conveys the primacy of the physicians in more subtle ways. In the July 31 episode, a New York ED physician describes, in a lighthearted way, her struggle to get respect in the clinical setting as a diminutive young female. She says she has been mistaken for a nurse! We do not see her add, "not that there's anything wrong with that." In addition, twice in the first episode we see patients credit physicians alone (Oz in one case) for saving their lives, even though nurses must have played critical roles, although perhaps in less flashy ways, such as extended patient surveillance. We assume Mr. Wrong did not directly cause this crediting, but that it was the result of prevailing social views. Still, shows like this reinforce those views by suggesting that physicians matter more, that only they save lives. The physicians on screen here do nothing to disabuse patients of the notion that they alone are responsible for outcomes.
 

A powerful trio confronts some shenanigans

Katie Duke holding patientTo the extent nursing does get attention on NY Med, the main themes are the quirky patients and unusual conditions that ED nurses encounter, with the occasional chance for the nurses to display some health knowledge and provide some care. Of course, a significant amount of the time spent on the nurses this season involves the experience of two of them as patients. Although their conditions are serious, and some of the patients the nurses treat also have serious conditions, the overall role of the nursing scenarios is fairly described as comic relief to the physician drama.

As in 2012, the three nurses who appear during this season of NY Med are Katie Duke, Marina Dedivanovic, and Diana Costine. All seem to start the season working together at New York-Presbyterian Hospital, and Duke introduces the three in the June 26 premiere as a "powerful trio." In that episode, all three seem to have some role, if only to comment, in the care of a patient who has sun poisoning as a result of surfing in Baja. This first case is a fair example of the show's nursing elements--the nurses get to show a little knowledge, suggesting that the patient may have second-degree burns, and maybe use a few words like "ambulate," but the main impression left is, what an unusual, awkward case! A physician examines the patient and provides a treatment plan. Diana quips that it's time for Marina to stop with the tanning beds.

trauma room "Man vs. 6Train"Many of the better scenes for nursing feature Duke, so it seems a shame when she is fired at the end of the first episode, which appears to reduce her role to some extent in the remainder of the season. About half way through the first episode, we see Duke crying on the street. Apparently, after six years at New York-Presbyterian, she has been fired and promptly escorted off the premises for an Instagram post of an empty trauma room after a trauma case. She titled the post "Man vs. 6Train…The after," as she shows us. The post credited nurses, physicians, and EMS personnel for trying, evidently without success, to save an unnamed patient. The hashtags include "Nymed." Some people were reportedly offended by the post. Duke admits the post was wrong and says she is sorry. It is not clear whether her promotion of the show itself played any role, but in any case, the incident points up the possible tension between health care and media attention. At the end of the episode, Duke re-appears at her new job, in the ED at Mount Sinai's Roosevelt Campus.

Duke practices nursing with considerable assurance, and at times she gets to display clinical authority. At one point in the first episode, we see her with a head-trauma patient, explaining his situation to him, trying to get a response from him. It turns out he has epilepsy. This is one case where an ED physician is involved, and when Duke and the physician both go to visit the patient later, Duke seems to disappear, while the physician accepts all the thanks for saving the patient's life. In the August 14 finale, Duke refers to the "shenanigans" that New Yorkers get into and from which the EDs try to rescue them. As an example, we see a very vocal patient with what seems to be a dislocated shoulder; Duke comforts him and notes that she sees no fracture. Katie Duke holding patientAfter he is treated and released, Duke describes the satisfaction of helping people in the ED and then moving on to the next case. At another point, Duke sees a young patient who did an intense crossfit workout after a long layoff. Duke says her "CPK levels" (creatine phosphokinase levels) are now really elevated, which means she "damaged her muscle tissue pretty severely." Duke tells the patient that had she not come to the ED, her kidneys would have started failing, accompanied by pain, nausea, and other problems. Duke stresses the importance of starting off easy when returning to an exercise plan. These scenes are fairly good, if brief, displays of nursing authority and knowledge. Plus, near the end, Duke zooms off on her motorcycle after work!

The other nurses also get a few chances to show nursing skill, even with the focus on patients who are real characters. In the July 3 episode, Marina Dedivanovic examines a patient who has chest pain, listening to his chest and describing the X-ray they will get. But much of this interaction is about how comically frightened the patient is of needles. Later, Dedivanovic banters with a tough elderly female patient, noting that this kind of New York lady is very entertaining. In the July 17 episode, Dedivanovic gets to deal with more characters. In addition to an inebriated female, who will be left to sleep it off, we see Dedivanovic display some knowledge and skill as part of team helping a man who badly injured his hand in a bicycle accident. Diana Costine and Marina Dedivanovic as patientsShe gives him pain medicine and psychosocial care, which he needs as an ED physician aggressively examines him.

The nurse-as-patient segments provide no great benefit to nursing. In the July 17 episode, we see Diana Costine speaking with a patient who has cardiac issues, explaining a readout quickly after they shock him back to a normal rhythm. That is not a bad example of health knowledge. Costine also notes that she has a heart problem herself, a chronic condition in which her heart beats very fast or pauses, and she faints. Later, we learn that she has in fact fainted; her eye is bruised. She sees a cardiologist, who explains that he recommends a pacemaker because of the risk that she could faint, fall, and seriously injure herself. She is upset and reluctant, at age 29, but with the support of her mother and boyfriend, she goes through with the operation and it seems to work out. In the August 7 episode, it's Dedivanovic's turn as patient. Having had a car accident in Miami, she arrives at New York-Presbyterian with a neck collar. She first goes to the ED, where she is impatient and vocal about the need for the collar to come off as soon as possible. Unfortunately, an ED physician and later a neurosurgeon explain to her that she will need to leave it on, it turns out for 12 weeks, to avoid the risk of serious permanent injury. Although Dedivanovic declares that her "life is over," she manages to return to work afterwards, with a new perspective on what patients experience. These scenarios are mainly displays of physician expertise.

On the whole, NY Med remains a show that is primarily about physician heroics. We urge Terence Wrong and his colleagues to show more of the role nurses play as expert, life-saving professionals, rather than mainly as vehicles to help show viewers interesting characters.

 

You can watch NY Med online here.

 

 

 

‚Äč