ABC's Grey's Anatomy: so chunky with Hollywood's contempt for nursing, you'll be tempted to use a fork. But use a scalpel!
March 27, 2005 -- Tonight ABC drew 16.3 million viewers to the series premiere of "Grey's Anatomy," a drama about surgical interns, especially attractive young female ones. Projecting edge but hedging with melodrama, the all-physician show combines elements of recent hospital shows like "ER" with overtones of "Sex and the City"--and "G.I. Jane." Show creator and executive producer Shonda Rhimes wrote the episode, and the "medical consultant" was Karen Lisa Pike, MD. We figured the show might be something like "House," which ignores nursing except to show physicians doing it, wrongly suggesting that they provide all meaningful care. "Grey's Anatomy" does that, but the premiere also embodies feminism's blind contempt for nursing, stressing that smart, tough, attractive women do not do the bedpan servant thing. Given the media's proven influence on the public, this widely seen premiere's regressive attack on nursing will likely do its part to exacerbate the nursing crisis that is taking lives worldwide.
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"Grey's Anatomy" is built around intern Meredith Grey (above--Ellen Pompeo), the daughter of a famous surgeon, and four fellow interns starting a long, grueling residency. Drill sergeant-like attendings and one vicious senior resident ("the Nazi") will train them through calculated abuse. Most of the interns, we are gravely informed, will not complete this sacred quest. All nine major characters are surgeons. Though only six of the 20 interns are female, three of the five major intern characters are. The attractive Meredith is the show's moral center, providing voiceover that ranges from confession to reinforcement of the show's vision of surgeons as the "Marines" of health care. She isn't sure if she's up to "the game," as the show reverently refers to surgery, but she "loves the playing field." One of the attendings, a cute guy Meredith picked up in a bar and brought home the night before her first shift (oops), begins one surgery by noting that it's a "beautiful night to save lives." Most of the writing isn't that bad, and some of the characters show potential, notably cutthroat intern Cristina (right), played with the right mix of nasty and pathetic by Sandra Oh. We could easily see the show being a hit, especially with "Desperate Housewives" as its lead-in. This episode's audience topped that of the original "ER" broadcast three days earlier.
Here are the major problems we see in the show's premiere, "A Hard Day's Night." The episode goes out of its way to endorse the surgeons' contemptuous views of nurses, and to reinforce a vision of nurses as unattractive, marginally skilled subordinates. Though nurses do occasionally appear, and even make a few care-related comments at the margins, the show is really a series of intense interactions among its nine physician characters. No nurse is ever named. Only surgeons play significant roles in care discussions, and only their actions matter in patient care. The nurses never interact with patients, and thus they provide no patient support. In stark contrast to real life, nurses provide no informal education to the interns, not once proposing a care option. And the show embodies the media's reflexive glorification of surgeons, reinforcing the dangerous fiction that they play a bigger role in health care than nurses do.
In "Grey's Anatomy," nurses are generally absent or peripheral. Virtually all are white females, and most are decades older than the attractive leads. The one notable exception is a young black male nurse, probably the biggest nurse character. At one point, he glances up from his newspaper (what nursing shortage?!) to let one intern know she'll have to wake the Nazi for something. In fairness, at one point during a surgery another nurse does note that the patient's blood pressure is getting too low. And one of the Nazi's commands is that the interns must come right away when a nurse pages them, though it's unclear if this is because lives hang in the balance, or if it's just another method of torture. Later, an annoying 15-year-old seizure patient prevails upon an unseen nurse to page Meredith 911 (stat), when at that time the patient is clearly in no distress. So much for nursing assessment and triage. Skilled nurses don't call physicians for no reason.
Two nurse-related themes merit special attention. First, the show carefully defines and endorses the surgeons' contemptuous views of nurses. At one point, the show has Meredith getting lost as she wheels the teenage seizure patient around the hospital. To underline how hard a time Meredith is having getting oriented, the show has the patient recall a prior hospital visit, after the patient had twisted her ankle doing rhythmic gymnastics: "I didn't get stuck with someone this clueless, and that was, like, a nurse." Meredith looks miffed but has no reply--she does feel as clueless as a nurse! Yes, yes, this patient is not a positive character. But as always in Hollywood's treatment of anti-nurse commentary, without any rebuttal, this will still reinforce prevailing stereotypes. It's not like the patient is saying something most people no longer believe. The key is in Meredith's reaction to the slur, which effectively endorses the teenager's ignorant view of nurses.
But the episode's masterpiece of physician contempt is an interaction involving Meredith, fellow intern Alex Karev, an unseen post-op patient, and an older, far less attractive nurse. Alex has diagnosed this patient's fever and shortness of breath as pneumonia, and he tells the nurse to start antibiotics. The nurse bleats: "Are you sure that's the right diagnosis?" Alex brings out the big guns: "Well, I don't know, I'm only an intern. Here's an idea, why don't you go spend four years in med. school and let me know if it's the right diagnosis. She's short of breath, she's got a fever, she's post-op. Start the antibiotics." Alex approaches Meredith, who has overheard all this, and says: "God, I hate nurses." Meredith observes that the patient may not have pneumonia, noting that she could be "splinting" or "have a PE." Alex replies: "Like I said, I hate nurses." Meredith is incensed: "What did you just say? Did you just call me a nurse?" Alex: "Well, if the white cap fits." Meredith stalks off. Alex tells another intern Meredith is "hot." Later, Alex responds to a page from this same nurse, who tells him that "4B's still short of breath." Alex sighs: "Look, give the antibiotics time to work." But the nurse actually persists: "The antibiotics should have worked by now." Alex starts to lose it: "She's old, she's freakin' ancient. She's lucky she's still breathing... Don't page me again." The nurse watches him go in silence. Still later, the chief of surgery stops by and quizzes Alex on the patient, who is still short of breath. Getting unsatisfactory answers, the chief asks the room (including Meredith): "What causes post-op fever?" Alex has no answer, but Meredith does: "Wind, water, wound, walking, wonder drugs. The 5 W's. Most of the time it's wind. Splinting or pneumonia. Pneumonia's easy to assume, especially if you're too busy to do the tests." The chief asks Meredith what she thinks is wrong, and she says: "The 4th W, walking. I think she's a prime candidate for pulmonary embolus." She explains how it's diagnosed and treated. The chief endorses her plan and kicks Alex off the case.
This powerfully illustrates what Suzanne Gordon has termed "dress for success" feminism, in which women who pursue traditionally male professions like medicine disdain those in traditionally female ones like nursing. In the "I hate nurses" scene, it looked for a second like the show was going to hold intern Alex accountable for his abuse of and refusal to listen to the nurse. But no. The real problem was that he did not know enough medicine, and was, as Meredith suggested, "too busy to do the tests." Of course, it would not occur to Meredith to say anything in defense of nurses. What she cares most about is that she not be regarded as one of them, which would mean she was a peripheral subordinate. The show is not directly adopting Alex's "hatred" for nurses, and the nurse did identify the patient's continuing symptom and raise it with Alex, in a kind of weak, nagging patient advocacy. But that nod toward reality just makes the nurse's essential irrelevance more persuasive. It was the chief of surgery who pushed the issue of the continuing symptoms; without him, it's not clear anything would have happened. The nurse looked as if she could have had 20 years or more of post-op experience, and the best she could come up with was: "are you sure that's the right diagnosis?" and "she's still short of breath!" Presenting no further assessment, she left the impression that she was more of a bitter peasant than a professional with clinical judgment. Would she really have let this first day fool just walk away, and make no effort to justify her concerns, or suggest alternatives that might save her patient? Maybe, but this would have been a great opportunity to show how nurses teach new physicians, and more broadly, that experienced nurses have a great deal of health knowledge, including medical knowledge. But that's not what the show wants from this character, who exhibits no attractive television quality. The care-related point it wants to make is that heedless, self-involved physicians miss things, but good physicians like Meredith catch them.
Thus, the nurse is merely an anonymous vehicle for Meredith's vindication. But it's not just that Meredith, with no experience, has the right answer. It's that Alex has had the effrontery to call her--her, the daughter of a surgeon!--a nurse, an ignorant but pesky servant. The episode is very interested in Meredith's bruised feelings, but the nurse--and indeed the elderly patient--is just a squeaky wheel, making noise because the plot needs oil. This nurse has been eviscerated for doing her job as a patient advocate, and the show could not care less. She is merely an annoying old plot device who serves to tell us something about the pretty, powerful characters who matter. This is more subtle than just saying you "hate" nurses. Note the specific take-down of nursing education: nurses have not been to medical school, therefore pretty much all they can do is mechanically identify symptoms. Viewers will not get that nurses are college-educated critical thinkers, or that physician abuse is a major factor in nurse burnout and a real threat to patients. Towards the end of their grueling 48-hour shift, Meredith and another intern muse that they wish they had wanted to pursue jobs that they evidently think would be easy, including kindergarten teacher and postal worker. The show thinks this is cute, but like the show's blithe disregard for the abused nurse, it is ugly to the core. As Meredith has just made clear, she would take great offense if anyone suggested she held a traditionally female job like teaching kindergarten, which she would doubtless consider well beneath her. This is the arrogant, ignorant posturing of the prep. school rich kid, someone who might also suggest that she wished she was black or poor.
The other pernicious nurse-related theme is the show's vision of nurses as dependent, marginally skilled subordinates in care settings. Meredith is paged again to the bedside of the teenage patient, now having seizures and surrounded by five frantic nurses, including the black male nurse (we would call him by his name, but he doesn't have one). The nurses inform Meredith that the girl is having grand mal seizures, and that the girl has already received certain Valium-like drugs. Meredith does a kind of spaced-out freeze here, with these words of the black male nurse echoing loudly in her head (and ours): "You need to tell us what you want to do!" Eventually Meredith recovers, initiates and performs defibrillation, saving the patient. (This reminds us of a recent code scene from "Scrubs," which also showed a young physician character who had to learn to tell the horde of helplessly expectant nurses what to do.) Here, the nurses are working hard, they have some technical knowledge, calling vitals, and they are impatient with Meredith's hesitation. But they have no suggestions for the intern. All they can do is await her command, and for her to take decisive action to save the patient. Of course, among five nurses, there would be plenty of experience to guide Meredith through the usual response to grand mal seizures, and probably for the nurses to simply do it themselves, and assume physician concurrence in the absence of an objection. Nurses are the ones who defibrillate the vast majority of the time. But the take-away message here is that five nurses with many years of combined experience have no ideas to offer a physician on her first day on the job. You need to tell us what you want to do.
Though the show should have realized it would infuriate many nurses, someone thought it would be a good idea to offer a feature on the ABC web site called the "Nurse's Blog." The first entry is a brief, gossipy and (of course) anonymous piece on the inexperience and impending suffering of the new crop of interns, and the danger it presents to patients. The blog picks up on one theme from the episode, which is that one of the interns will be nicknamed "007" because he or she is likely to kill patients. This theme is revealing, because we don't expect to see any recognition that an inexperienced nurse could kill patients; after all, the show thinks they're pretty much interchangeable. Nor is there any indication, as there is none on the show, that it is nurses who play a key role in preventing patients from dying of "July syndrome," named for the month new interns appear in U.S. hospitals. This blog, like the show itself, positions nurses as spectators commenting on the actions of the surgeons who matter. The blog's tone is that of a cackling harpy, enjoying the misfortune of her betters because that's all she has. I'll get you, my pretty! The second blog entry continues in this vein, clucking about how Meredith's mother's "old scrub nurse" would enjoy "torturing" her offspring if she were still working. Then the anonymous OR harpy mocks the unfortunate intern who botched an appendectomy in the first episode, noting that "I'm not even a surgeon and I could do one!" But this entry also goes on to present the classic vision of nurses as looking for hot physicians, suggesting that the "floor nurses" are all aflutter over some new neurosurgeon who is "eye candy in a lab coat."
We don't have time to dissect fully the episode's glamorization of surgical sadomasochism and of excessive physician hours (which studies show harm patients), or the extent to which the show embodies the media's mindless overvaluation of surgeons. At one point, an attending chastises an intern for promising a family that a surgical patient would survive, noting that only God can do that, and he hasn't "seen Him holding a scalpel lately." We think the show doth protest too much, and in any case, even the comparison is pretty flattering. But we will propose an admittedly oversimplified analogy: surgeons are to nurses what bulging muscles are to the human immune system. Huge muscles are certainly useful, and they might even save your life once in a while, but we should not overstate their overall value to human survival and quality of life. Of course, society's overwhelming focus on flashy, lucrative physician specialties goes hand in hand with the alarming marginalization of nursing and public health that we now face.
The creator and executive producer of "Grey's Anatomy" is Shonda Rhimes. On March 25, 2005, NPR broadcast a somewhat fawning interview with her and one of the show's black actors. Among her comments [emphasis added]:
What I really like about having a show, and being an African-American woman, and being on a major network, is that there are things that people don't normally see, or that people see every day and they just assume are true. And one of the things, one of the sort of mandates that I've had about the show, is that (a) actors of color are going to get to do roles that are much more interesting, and (b) if you're watching TV in middle America and have never seen a person of color in your life, you're going to come away with a different perception than what they'd normally give you on television, because I didn't grow up as a hooker, I didn't grow up in a ghetto, but the way people look at people on television is the way they perceive the world. And for me the idea of the show, part of it, is that we can change the assumptions that people have simply by the images they see in the background of the show.
We could not have explained better why "Grey's Anatomy" will likely have a negative effect on public health, at a time when most of the world confronts huge nursing shortages. We trust that the show will respond to nurses' concerns about its nurse stereotyping with this same keen awareness of the media's power, especially since research confirms Ms. Rhimes' view that entertainment television is a powerful force in shaping public views and actions, including in the health care context. Indeed, the show could tell its millions of viewers that nurses are highly skilled, autonomous professionals who save lives and improve outcomes every day, and do it without asking physicians what to do. We hope Ms. Rhimes can see that this is not a game.