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"You're the pig who called Meredith a nurse...I hate you on principle."

April 3, 2005 -- Proving that its series premiere was no fluke, tonight's episode of ABC's "Grey's Anatomy" offered 18.2 million viewers more of its surgical intern characters' explicit contempt for nursing. But perhaps the episode's most notable feature was its relentless portrayal of physician nursing, as the physicians basically handled all meaningful patient care by themselves. Show creator Shonda Rhimes wrote the episode. The show's attractive lead actors and yearning guitar pop soundtrack seem to be persuading viewers to overlook some bogus writing and less than credible plotting, and it is shaping up to be a major new force in fostering inaccurate attitudes toward nursing.

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The episode quickly disabused viewers of any lingering doubt as to whether the show endorsed last week's vicious anti-nurse bigotry, which involved the beautiful, sympathetic lead character Meredith angrily weathering insults to the effect that she was like a nurse. This week, Meredith's friend Cristina (right) greets male intern Alex as follows: "You're the pig who called Meredith a nurse...I hate you on principle." Any questions about where the show stands on nursing? Do you think Cristina's comment would have been any different if Alex, instead of calling Meredith a nurse, had called her a "stupid bitch?" This show clearly cares nothing about the nurses who are the objects of its characters' scorn. It only wants to show how hard it is to be a female physician who has the misfortune to share her gender with most of the nursing profession.

As we noted last week, this is blatant "dress for success" feminism, an expression of contempt for a traditionally female profession by bright, ambitious women who think they have left all that lowly "women's work" behind in pursuing high-status, traditionally male professions like surgery. Never mind that real interns learn a tremendous amount from experienced nurses. Never mind that the kind of comments the show is endorsing are based on the same misogynist stereotyping that has long made women second class citizens across the board. You've come a long way, baby! Don't question patriarchal oppression--embrace it.

In another scene, Meredith (right) gets into a dispute in the nursery with a pediatric intern about the proper care for a particular newborn. The pediatric intern, wearing scrubs with no lab coat, immediately and aggressively defends her territory, practically kicking Meredith out. One of her strongest comments: "I'm a doctor too, you know." This may be mostly a reaction to perceiving surgical arrogance, but in the context of the whole show, the subtext is clear: perhaps I am wearing scrubs like a nurse, but I am a physician and therefore worthy of respect, so back off.

Most of the show consists of physicians handling all aspects of patient care, with little or no involvement by nurses or anyone else. For instance, the pediatric intern and Meredith are pretty much the only caregivers we ever see in the crowded nursery, though a surgical attending and pediatric resident do stop by for a brief showdown. The message: physicians provide all significant direct care to newborns 24/7. They may as well call it the "doctory."

The denursification is also notable in what is perhaps the main subplot, which involves a critically injured rape victim who gets emergency surgery, and does not regain consciousness till the very end of the episode. The show presents the victim's care as directed entirely by physicians. The apparent ED attending hands her off to the surgical physicians, who spend the remainder of the show watching over her, especially since she has no family present. For an entire night, the surgical attending Derek (right) sits by the side of the rape victim, but no ICU nurse ever appears. Right. Eventually, the perpetrator staggers up and collapses in front of our intern heroines--we know it's him because of a tasty plot device we need not get into here--and he too is almost immediately in surgery. In these scenes, the physicians dominate all aspects of the action. Nurses are absent, apart from the usual fleeting, peripheral appearances in the OR.

In reality, rape victims at major urban teaching hospitals like this one are typically under the care of Sexual Assault Forensic Examiners (SAFE). These are highly skilled forensic nurses adept at providing the physical and psycho-social care victims require, and at the complex, sensitive task of collecting usable physical evidence for prosecution of the crime. In the OR, the surgical attending mentions that the rape kit was negative, but we never see the forensic nurse who undoubtedly did the rape exam in the ED. Of course, psycho-social care might not initially have been seen as a huge priority for this unconscious victim, but the show does portray the physicians worrying over her lack of supportive family or friends, suggesting that they are trying to manage such things while she is unconscious. And she does finally wake up--apparently with only the surgical attending present. Nursing would also be central to the victim's physical care, in the emergency, surgery and post-op contexts. Moreover, forensic issues remain vital throughout this episode. Yet Meredith is assigned the job of protecting key physical evidence, instead of the forensic nurse, who has the expertise. Forensic nurses are not even mentioned. Because no nurse plays any significant role, the impression is that only physicians matter, and physicians get credit for work that nurses do in real life.

In a smaller subplot, intern Izzie (right) spends a great deal of time trying to help a slightly wounded Chinese ED patient who refuses to be sutured. Unable to find a translator, Izzie finally gives up, but when she sees the woman leaving, she follows her outside to the rainy parking lot. There we see a bloody younger woman, perhaps the Chinese woman's daughter. They refuse to come inside because the daughter is an illegal alien. Izzie cannot persuade them to do so, so she stitches and bandages the daughter's head wound by herself in the rain, then tells them to return later so she can check on it. From the older woman's arrival in the ED until the waterlogged discharge, there is no sign of any nurse involvement. In real life, nurses would have provided much of the care for these two. They would have taken a leading role in negotiating the language and cultural barriers, advocating to have skilled plastic surgeons suture the young woman's face (rather than a brand new intern with marginal skills), ensuring that the patient's care would remain confidential from law enforcement, reassuring the patient of that confidentiality, and providing discharge planning. All of these roles call for clinical skills that ED nurses have, and that, it's safe to say, new surgical interns typically do not have. And the chances that a physician, rather than a nurse, would be the one to leave the ED in the pouring rain to see a patient in the parking lot are very low. We mean low.

In all likelihood, the show will stop having its physician characters express their contempt for nurses directly, and simply have the physicians spend half their time nursing while no substantial nurse character ever appears, accomplishing the same thing indirectly. Watching "Grey's Anatomy," we can imagine young females all over America thinking: "Wow, maybe I could be a surgeon." But we can't imagine a single self-respecting viewer thinking: "Wow, maybe I could be a nurse."

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