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"We're all 17 years old"

September 28, 2006 -- This season's first two episodes of "Grey's Anatomy" included handmaiden portrayals and physician nursing that flowed naturally from the show's superficial approach to health care. In the September 21 premiere, written by Shonda Rhimes and seen by 25 million U.S. viewers, experienced nurse Olivia confronts a sick newborn much as a deer faces headlights. Intern Alex orders Olivia to get him IV materials as he whisks the baby out of the flu-stricken ED. At first Olivia can only babble "How old's that baby?", and sputter that she's just been sent down from the floor to handle the flu overflow. But she does recover enough to snap that the infant has to be admitted to the hospital--which Alex of course ignores, since he's all about saving lives. In tonight's episode, written by Krista Vernoff and seen by 23.3 million viewers, nurse Tyler informs intern Cristina that he was part of a team that just saved a life in a code. But we get no specifics. And Tyler tells Cristina only to justify his failure to earn the $20 she paid him to act as a lookout, so she could have sex with her boyfriend, an ailing attending surgeon, in his hospital bed. Tyler seems to get the last laugh, but he's still a lackey who accepts $20 tips for tasks other than his real job. Later, we see what Tyler really does for patients. He pages intern George to tell him that a pre-op lung cancer patient has been shoplifting and is planning to leave without having her operation. Then Tyler steps back to let George handle the important health care issues. Seriously? Seriously.

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"Grey's Anatomy" ranges between teen soap opera and frothy sex farce. These two episodes both revolve to a significant degree around a pair of panties belonging to lead character Meredith Grey. Each episode of the show also has a cool theme about life and stuff. It is explored in Meredith's inane opening voice over, which often sounds like something that was text-messaged by a bored high school student from the back of English class. For instance, the season premiere focused on the plight of intern Izzie, whose grieving for the dead patient she loved has taken the form of a kind of quasi-catatonia. So viewers were treated to the following disquisition on the Nature of Time from the chirpy surgical sage:

In the OR, time loses all meaning. In the midst of sutures and saving lives, the clock ceases to matter: fifteen minutes, fifteen hours. Inside the OR, the best surgeons make time fly. Outside the OR, however, time takes pleasure in kicking our asses. For even the strongest of us, it seems to play tricks--slowing down, hovering, until it freezes, leaving us stuck in a moment, unable to one direction or the other.

One scene in the season premiere has a physician explaining Meredith's conduct to one of Meredith's boyfriends. She says physicians are "socially retarded" because all they've done since high school is study science: "We're all 17 years old; this is high school with scalpels." That is certainly an accurate description of "Grey's Anatomy." But it would be okay if the show just stuck to what it does well. And for that, it could just as easily be set in Meredith's group house, in Joe's Bar, in a high school, or in Hollywood.

The problem is that the show persists in pretending that it's about what serious health professionals really do in a modern hospital. It constantly invites viewers to laugh, cry, sigh and moan along with the brilliant 'n' beautiful physicians as they bravely confront grown-up issues of life and death. It's almost like health care is as important as panties! But in a hospital setting, where adults cause real things to happen to real people, the show's adolescent perspective makes a mockery of much that it purports to revere, from organ transplants to quarantine procedures to the roles of vital health professionals.

Nursing in particular stands little chance of a fair portrayal in such superficial depictions of health care. That's because those who create them tend to hold fast to prevailing stereotypes of nurses as vacuous physician assistants. The earth is flat, and that's all there is to it. These creators seem certain that physicians are the only health workers who matter--that's what society and its media have told them every day since they were children--so every major character is a physician. This means the physician characters will spend a lot of time doing vital, interesting things that nurses actually do, and the nurse characters who do appear will be peripheral, disposable dramatic foils for the stars.

Early in the "Grey's" season premiere, we see intern Alex, and Alex only, greet a paramedic who is rushing into the ED with a baby in his arms. The paramedic reports that the "premature infant" was found in a trash can at a prep school. Alex notes that the baby is dehydrated and asks why no IV was started. The paramedic says he could not find a vein. Alex then starts to issue commands to nurse Olivia, who has just entered the ED along with a number of other health workers and patients. (click to see the filmclip in Quicktime.)

Alex: I need to get an IV access. Get me an I.O. needle, and I need a neonatal intubation kit.

Olivia, who has been staring at the baby, looks shocked and baffled, as if she has never seen a sick infant before.

Alex: Olivia, go ! Move! Now!

Olivia (weakly): They pulled me from the floor...I'm just down here helping with the flu overflow. Alex, how old's that baby?

Alex, realizing the danger to the infant posed by an ED full of flu victims, scoops up the baby and starts to head out of the ED.

Olivia (now irritated and panicked): Wait-wait-wait! What are you doing?!

Alex: If you think I'm going to leave this sick, premature infant in the ER--

Olivia: He has to be admitted--you can't just take him!

Alex: Just page Addison Shepherd. Tell her to meet me in the NICU.

This one quick scene is a masterpiece of professional assassination. With just a few quick strokes, the show has painted a damning portrait in shades of handmaiden and battleaxe. It presents an experienced nurse as (1) a pathetic ninny who comes completely undone in a pressure situation, (2) a mindless physician lackey who needs to be told the most basic things about care, and is really fit only to page a physician, and (3) a petty bureaucrat who would rather enforce administrative rules than save lives. Alex, an arrogant surgical intern who has at times been uncertain, now takes command. He instantly makes key observations, issues appropriate "orders," and thinks quickly outside the box: the vulnerable infant must be moved to avoid flu infection. (That is an idea, incidentally, that would be at least as likely to occur to a nurse as it would a physician.) Alex is a life-saving professional, but the only rational reaction to Olivia here is: What an idiot.

Nothing redeems this vision of nursing, to say the least. For the rest of the episode, attending OB Addison Shepherd and physician colleagues handle all patient care and family relations surrounding this infant. This includes an extensive inquiry into the mother's identity that involves several prep students and their parents. No nurse is involved in that, and none plays a noticeable role in the NICU care the baby receives. In another plotline, after a potential plague exposure at the hospital, some physicians and patients are quarantined. (No nurses, it seems, since they don't have much direct contact with patients.) At one point, chief resident Miranda Bailey handles, through a locked hospital room door, all the psychosocial care of an extremely distressed quarantined patient whose wife has just died. This patient receives no nursing--except from Bailey.

In tonight's episode, we see intern Cristina enter the hospital room of her boyfriend, attending Preston. She takes off her scrub pants and top and mounts Preston on his bed, saying that he doesn't have to be able to touch to enjoy. But Preston's very proper parents choose that moment to burst in (oh, my, God!). Later, Cristina chastises Tyler (right), for failing to keep watch. He explains that "we" had a code blue and "saved the guy's life." Cristina still wants her $20 back. Tyler smugly reports that he used it to buy coffee for everyone to celebrate the fact that they "saved the guy's life." He walks off, and the nearby Meredith notes with a smile that it's not Tyler's fault that her friend is a "dirty dirty stripper."

We do see that this is a token effort to address our concern that nurses be seen as the lifesavers they are, rather than mindless twits like, oh, Olivia last week. We appreciate the gesture, but this is where the silly sex farce imperative gets in the way. The show is too busy with the interns' panties to actually show us what a skilled nurse might do in a code, so this offhand comment is all we get. Tyler could have done no more than hand a physician an instrument or carry out simple "orders," for all viewers know. And since early 2005, this show has done virtually nothing to suggest nurses do much else.

And consider the show's vision of Tyler as lookout. Cristina obviously would not have offered $20 to a physician to do this. If it was a friend like Meredith, she would have offered a favor, or nothing. And Tyler is not her friend. So the scene suggests that he accepts what amount to tips, and that he did not expect to have anything better to do than be a paid sex lookout for a physician. Yes, he abandoned his post for the code, but that was unexpected. In the absence of that, Tyler apparently saw it as OK to spend his work time earning Cristina's $20 and ignoring his patients. After all, we suppose, nurses aren't usually very busy unless physicians need them for something. Oh, you say maybe Tyler planned all along to just take the money without looking out? That's possible, but also pathetic, like he's some low-rent hustler looking for spare cash. Hah--I stole $20!

As this scene shows, the "Grey's" nurse-handmaidens do come in different colors and genders, and the same is true of the physicians. The show's vision is not about those stereotypes, but equally flawed professional ones--it's a meritocracy based on facile misconceptions. Thus, physicians are the pretty, clever ruling class, the masters of all health care.

And nurses are sniping serfs whose lives revolve around the needs and whims of their betters--their dullness helps the physicians shine. Nowhere is this more evident than on the "Nurse's Station" blog the show persists in maintaining on the ABC web site. There, nurse "Debbie," a minor "battleaxe" character who occasionally appears on the show, posts weekly messages. These amount to gossipy, somewhat petulant stargazing of the personal lives of the heroic physician characters. But who could blame Debbie? Nothing happens in her own life.

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