In the midst of life we are in death
August 21, 2005 -- Tonight's series finale of HBO's "Six Feet Under" was a fitting sendoff for the funeral-directing Fisher family. It offered a powerful, if at times overwrought, vision of human mortality. But the episode also marginalized nursing in two significant subplots, an ironic slight given that nurses may confront death and dying more directly and more often than any other clinical health care professionals. The finale, "Everyone's Waiting," was written and directed by show creator Alan Ball.
By the end of the episode, all of the show's major characters had undergone major shifts in their lives. Most of these flowed directly from main character Nate's recent and unexpected death from an arteriovenous malformation. Alan Ball evidently felt that Nate's wife Brenda (right) was not overwhelmed enough by her husband's death, the unraveling of their marriage just before it, Nate's last minute infidelity, the potentially compromised health of the baby she was carrying, and the prospect of raising Nate's unborn child and his three-year-old daughter from a prior marriage by herself--assuming she could fend off the efforts of Nate's mother Ruth to take the three-year-old. So to make things interesting, Brenda went into premature labor!
At the hospital, we see Brenda's delivery of her distressed newborn daughter, a scene of her in the post-partum unit, and a couple of scenes outside the NICU where her daughter later receives care. Nurses seem to be part of the delivery scene, but they say nothing. One apparent nurse silently transfers the newborn from the obstetrician who delivers it to the warmer, but only the physician speaks, offering limited guidance and reassurance to Brenda. No one even bothers to answer her frantic question about where her baby is going (presumably the NICU) as the baby is taken from the room. Of course, all this heightens Brenda's sense of fear and abandonment, but it also suggests that nurses are silent handmaidens.
In the post-partum and NICU scenes, no nurse appears. This is especially striking for the NICU, where in real life nurses are constantly interacting with patients and parents. Here, a neonatalogist tries to provide Brenda with some support and some sense of what's going on, though he refuses to let her even see her baby for some time, for reasons that are never made clear. Of course, maternal contacts, including skin-to-skin care and breastfeeding, have been shown to be significant positive factors in outcomes for premature infants, but these are courses of treatment that nurses would be more likely to promote and implement. The episode's denursification no doubt heightens the drama of Brenda confronting her personal tragedy with no real support from the cold health care system (and with constant intrusions from Nate's ghost, who keeps telling her how damaged the baby is). But why does such drama always come at the expense of nurses? Yes, the physicians may be awkward, but they are still seen as the only providers with significant expertise. They are portrayed as saving her baby, and Brenda manages to thank the neonatalogist. "Six Feet Under" evidently thinks that nurses have nothing to do with the saving lives thing.
Perhaps nursing's perceived marginal relevance to serious health care practice explains why another one of the show's characters, Vanessa (right), gleefully abandons her nursing career with no more than a backward glance. Vanessa is married to Rico, who co-owned and ran the funeral home with the Fishers. Rico has chafed under the workplace limits imposed by the relatively uptight Fishers, and Nate's death allows him to go out on his own with the proceeds of his share of the business.
In the preceding episode, Vanessa apparently got off early from her nursing job so she could help Rico (below) handle an understaffed wake. This suggests that some nurses have so little to do that they can get free for supposedly more important things at the drop of a hat. At the viewing, Vanessa comforted the sister of the deceased, an Iraq war veteran who had committed suicide after losing three limbs. The veteran's mother speculated that some "night nurse" at the hospital had given the veteran the lethal drug he used, noting that the facility was so "understaffed" it would "hire anyone," though in fact viewers knew that the vet's sister had given him the drug. (This arguably rebuts the nurse overstaffing implication of the Vanessa plotline, though maybe the show sees VA hospitals as different from Vanessa's.) Later, Vanessa told her family that though the viewing was sad, she "liked being there for people." This may suggest that she was "being there" more as a funeral director's unskilled assistant than as a nurse. But some might find saving lives just as valuable a way of "being there" as providing a few minutes of emotional support at a viewing. Go figure! Of course, in most Hollywood products, it is physicians who provide the emotional support that nurses typically do in real life. So Vanessa's comment may reflect the view of "nursing" in that imaginary world, a place where nurses provide neither skilled technical care nor significant patient support or education.
In the finale, Vanessa eagerly looks forward to joining Rico at the new funeral home, which will help them provide a better life for their children. She says that working the viewing was "sort of like being a nurse, except without all the blood and bedpans and pills. And I got to wear better clothes!" So Vanessa's work at the viewing, for which she evidently received no training, was pretty much the same as the work of a registered nurse, which requires years of specific, college-level science education. Of course, presumably she would draw on her nursing experience in providing emotional support, as her comment about it being "sort of" like nursing suggests. But her nursing background was given no credit for the supposedly good work that she did at the viewing. More disturbingly, the work we saw her do was not especially impressive. She suggested to the veteran's distraught sister that life is still worth living because of children, and barely managed the sister's understandably tart response. And Vanessa's summation of nursing as a mix of blood, bedpans, pills, comfort and bad clothes obviously reflects little understanding of the profession.
Of course it's easy to imagine a nurse choosing to leave nursing today, when the profession continues to confront a critical shortage. Plausible reasons would include short-staffing, poor relations with physicians and other nurses, and the normal stress and difficulty of a highly demanding job. But this show appears to know nothing of that, and it has not earned this plotline. It is simply presenting nursing as an unpleasant throwaway job that people do till something better comes along, including a position in a family business that apparently requires no particular training at all. Imagine a physician character chucking a medical career so casually.
HBO promoted the show's final year with an ad campaign centered around the idea that "everything ends," a theme that Alan Ball himself echoed in a series tribute accompanying the finale. And the last few episodes certainly lived up to that promise, killing the show's main character and (at the very end) flashing forward to the projected deaths of all its major characters. We believe that the mass media's egregious misrepresentation of nursing will also end. But episodes like this suggest it won't be soon enough.
Also see our July 31, 2005 analysis of the "Six Feet Under" episode "Ecotone."