"We do try to keep the doctors from killing you"
September 23, 2009 -- The series premiere of NBC's drama Mercy presents a group of attractive young Jersey City hospital nurses as downtrodden working girls, failing to get the respect they deserve from physicians or patients. Lead character Veronica Callahan displays advanced psychosocial and life-saving skills, though the show attributes the latter to her tour of duty in Iraq, rather than nursing education and experience. Like the lead characters on Showtime's Nurse Jackie and TNT's HawthoRNe, Veronica is a fighter, telling physicians off and doing what she thinks best to protect patients. Unfortunately, the show seems to think she reports to the physicians, a major flaw. As in the premiere of Jackie, Veronica warns a young physician that a patient may have a critical problem; he ignores it, the patient dies, and the nurse tears into him. As on HawthoRNe, Veronica's disregard for protocol repeatedly gets her in trouble with superiors, in her case the apparent chief of medicine. Like Jackie, Veronica is self-medicating, in her case with alcohol and "delicious Paxil" for what seems like PTSD from the war. As on Jackie, Veronica's nurse sidekicks include a smart but clueless novice who favors mockable patterned scrubs, as well as a wisecracking gay man. Veronica is separated from her pugnacious contractor husband, who persuades her not to divorce him, though she still has a strong thing for a hot surgeon she hooked up with in Iraq--and who has pursued her to her new hospital. So like Jackie, Veronica looks set for a love triangle involving her working class husband and a colleague with more education. Her nurse friend Sonia connects with a nice, funny police officer, but she is desperate to escape what the show sees as the violence and unpaid bills of the working class; she wants a wealthy Manhattan lawyer. In any case, like the two summer shows, Mercy is raising important nursing issues other hospital shows rarely have. The premiere ("Can We Get That Drink Now?"), written by show creator Liz Heldens, drew 8.2 million viewers.
An early scene sets the tone for Veronica, and to some extent her nurse friends. We see her in her kitchen on a bright sunny morning, listening to the radio, on which an announcer is reporting that there is "traffic backed up at the Holland Tunnel heading into lower Manhattan." Like people trying to get into the Big Apple, into the Big Time, nurses like Veronica and Sonia are seeking something more, maybe something more than what the show sees as their blue collar lives. But reality quickly intrudes. Veronica hears a helicopter outside. She looks out the kitchen window and is sprayed with bullets. It's a flashback related to her war service. Of course, the flashback is not real, but what is real is that she is seriously unwell, and she will not have any easy path forward.
Soon after, a scene that begins with Veronica at a local coffee shop reveals what seem to be the major themes regarding Veronica's nursing. There is a serious auto accident outside and she runs to help. The man who was driving the car is badly hurt, and his female companion is panicking and screaming for a "doctor" because she's bleeding. A man in a suit approaches and tells her he is a doctor. He starts looking at her head. Both of them ignore the driver, who is slumped over the wheel--obviously more seriously injured. Veronica leans in to assess the driver, pulling him back into his seat. We see that a soda bottle protrudes from his chest. His companion notices and starts babbling again. Veronica says she thinks he has a tension pneumothorax. Veronica asks the physician if he wants to "jump in here," but he declines, saying he is a dermatologist. So Veronica, calling him "dermatologist," sends him to get "a needle or a knife, and something to sterilize with." The woman in the car unravels further, yelling about what is going on. Veronica grabs her by the nose: "Hey, lady, listen, your boyfriend--" Woman: "Fiance." Veronica: "OK, fiance. His chest is filling up with air. If I don't relieve the pressure in the next 30 seconds, he will go into cardiac arrest and die. Now help me pull his shirt up." The dermatologist returns with the materials Veronica requested. She explains what she's doing: "Now, I make a hole in his 5th intercostal space. We're going to need a chest tube, hand me that straw." She decompresses his lungs, using the straw to allow the air to escape, and the traumatic procedure shocks his fiancee. But the man immediately starts breathing. She saved his life. The dermatologist looks amazed, and asks where she learned to do it. She answers, "Iraq."
We see Veronica arrive with the patient and paramedics at the hospital, Mercy, where she also works. She tells the staff what happened and says the patient will need an X-ray. Instead of thanking her, the chief of ED medicine Dan Harris scolds her: "What the hell's going on here! Who ordered all this?" Veronica: "Me." Harris: "Under what authority? You're a nurse. OK, a nurse? I'll handle it." But that's not enough: When the patient's fiancee overhears that Veronica is not a physician, she shows similar gratitude: "You're not a doctor? After all that, you're just some stupid nurse? If he dies, if he has so much as a scar, I swear to God I will sue you, the hospital, and the city." Veronica smiles bitterly.
So here is Veronica, displaying considerable life-saving skill, adaptability, and strength under pressure. The helplessness of the dermatologist is an interesting touch, and obviously extremely rare for Hollywood, in which physician characters are often expert at most or all specialties. But this shows that not all physicians are better than all nurses at all tasks, which might surprise non-nurses. Veronica's save with found materials is the kind of thing concierge physician Hank Lawson of USA Network's Royal Pains often does, but of course it would also be a useful skill in a war zone. Here the show also establishes what will be a recurring theme: nurses like Veronica not only get little credit for their expertise, they are sometimes actually attacked for having the temerity to use it. No rational system would disapprove of an experienced critical care nurse saving a patient's life this way when there was no other alternative, especially when paramedics routinely perform this procedure in the field when required. And the reaction of the patient's fiancee, while perhaps not totally credible, does suggest something of the physician glorification and lack of respect for nurses in society at large. Veronica seems to shrug it off, but that kind of disrespect undermines nurses' view of themselves.
However, nurses have life-saving skill by virtue of their nursing training and experience, not just if they happened to serve in a war. And while the first scene with Harris at least implies that Veronica reports to the ED physician, later ones make it pretty clear that the show thinks nurses report to physicians, which is of course contrary to the reality that hospital nurses are autonomous professionals who report to nurse managers. Right after the Harris scene, we see Veronica speaking to a more senior physician in a large office; presumably he is the chief of medicine. She seems to be in trouble because of what she did in the field, or at least because she did not turn the patient over to Harris fast enough. Apparently Veronica has had run-ins with Harris in the past. The senior physician, who obviously likes and respects Veronica, is trying to get her to play nice and take better care of herself generally. She reports that she's doing fine, thanks to "delicious Paxil."
The show's novice nurse character is Chloe Payne. We learn that she has a master's degree from the University of Pennsylvania and that she graduated at the top of her class, but she is also painfully naïve and wears patterned scrubs, for which the other nurses mock her. Chloe seems similar to the Nurse Jackie character Zoey, yes, right down to the rhyming name. And HawthoRNe also has the novice nurse character Kelly. It seems to be a requirement for the new nurse shows. These characters can be embarrassing--at times their cluelessness seems exaggerated--but it does help the veteran lead characters establish that they have relative expertise. And of course inexperienced physicians have long served a similar purpose in hospital shows, though they don't usually seem to be quite as wide-eyed and silly as the nurse characters. It's great that Mercy is suggesting nurses get graduate degrees--even Jackie and HawthoRNe have not done that--but we know of at least one person closely associated with Penn who was disgusted with the show for showing one of the great school's graduates as such an idiot. In one silly scene here, an older nurse asks Chloe to turn off a "dead" (presumably brain dead) patient's life support, which Chloe seems to be too sentimental to do; Veronica has no such qualms.
Chloe also has a couple brief interactions that illustrate the show's fuzzy notion that the nurses report to physicians. We see a senior nurse who seems like a charge nurse walking with Chloe. She tells Chloe that normally "we" like to hire nurses with more experience, but notes that Chloe was at the top of her class, and also, "we're desperate." That sounds like the nurse had something to do with the hiring. Yet it is ED medical chief Harris who introduces Chloe to her nurse colleagues, as if he is in charge of nurse hiring. Maybe the show thinks nurses do the hiring, and physicians do the managing and firing?
The other nurse characters are Sonia Jimenez, who appears here mainly in scenes related to her personal life, and Angel Lopez, who is clearly a more minor character than the other three. He appears intended to play a role similar to that of the charismatic, witty Mo-Mo in Nurse Jackie--at least they resisted calling him "Jo-Jo"--but unfortunately, the character of Angel seems to have less to offer. His character is the second of three male nurse characters in the three new nurse shows who is gay, which does not reflect the actual proportion of men in nursing who are gay. Some may feel that this is reinforcing the most common of the male nurse stereotypes, though it's not the responsibility of any of the specific shows to create a demographic that perfectly reflects reality. And since Angel seems to be Latino and Sonia African-American, the show is at least promoting diversity in the profession.
Another plotline follows the nurses' interactions with a young ED physician named Whitaker. Early on, this physician brings them some donuts, saying they are for "the best nurses in the state." Presumably this was done at least to set him up as someone who is trying to make some effort, but even here, there is something degrading about it, as if nurses' cooperation (like that of a dog) could be purchased with treats. In fact, that has been suggested not only by a physician character in an awful 2004 ER episode, but also by a real Cleveland Clinic physician, who actually advised readers of a 2005 Good Housekeeping article that they could get better care by "supplying the staff with treats." It's not clear how much of this the show intended to convey.
In any case, it is clear that the show views Whitaker as dangerous. In one scene, a young male gunshot victim is coding and needs defibrillation. Whitaker does this--yes, sadly, even Mercy has physicians do ED defibrillations, which nurses generally do in real life. But Whitaker forgets to warn others to get clear of the patient when he applies the paddles, and Angel gets a painful shock. Later, Sonia wonders if they should tell Harris about Whitaker's ineptness. Veronica responds that Harris won't listen, so Sonia should "just let the other nurses know to watch" Whitaker. This is not an inaccurate picture of how nurses might try to compensate for a new and incompetent physician.
But Veronica herself will have trouble handling Whitaker's care of this same young man. In treating him, Veronica notices a rash, and tells Whitaker in the nicest, most respectful way that it might be a fat embolism. She suggests that heparin might be helpful. Whitaker seems somewhat taken aback that a nurse would be suggesting something like this. He says heparin is a blood thinner, not indicated here. She says they used it on the front lines, and studies show it can help. He manages to say, unconvincingly, that he'll look into it. It's clear she believes he will not, and that is in fact what happens. Unfortunately, as Chloe is wheeling the patient down the hall, he does code because of just such an embolism, and it soon becomes clear that he is brain dead.
Veronica can't help confronting Whitaker about this. As she approaches, he is busy talking to another young physician. Veronica asks if he has heard about the kid. He has, but doesn't seem much concerned about the young man's fate. She asks if he tried the heparin. He tells her that was a "Hail Mary" pass and turns back to his physician friend. Veronica throws a white powdered donut at the physician's head, and says Hail Mary passes are what they try when trying to save a kid's life, calling the stunned physician an "unbelievable moron." Unfortunately, the kid's distraught mother is nearby and overhears. We see Veronica once again with the senior physician, who says he expects the mother to sue them as a result of her reckless outburst. He assures Veronica that he is willing to "fire" her if necessary to keep her in line, obviously reinforcing the idea that he is her manager.
Later, we see Chloe outside the kid's room. We can see his mother inside, sitting beside her son. The older nurse from earlier scenes tells Chloe that while the mother has sat with her son all night, she, the older nurse, has been keeping the "transplant vultures" at bay--a surprisingly irresponsible way for Mercy to present organ donation, as studies have shown that negative portrayals of organ donation on prime time shows like Grey's Anatomy actually discourage people from donating. Chloe goes in and comforts the grieving mother with enormous, trembling empathy.
This basic plotline is like one in the first episode of Nurse Jackie from June 2009, in which Jackie similarly warned the new physician Cooper about a possible problem and was ignored, after which a young male patient died. There, as here, the nurse later confronted the physician with harsh criticism, illustrating nurses' technical knowledge and patient advocacy role, though of course neither nurse pushed her views hard enough to save the patient. And as on Jackie, the needless death sends the nurse somewhat over the edge. Jackie forges a donor card, and Veronica makes a reckless remark in front of the mother and actually throws something at the physician (a reversal of real life, as throwing things at nurses is a hallmark of the disruptive physician, a real problem).
Another important care-related plotline involves an older female patient with end-stage liver cancer named Mrs. Borghouse. In an early scene, we see Veronica caring for this difficult patient. Of course, there's little reason for an ED nurse to care for an apparently admitted oncology patient, but whatever. Veronica takes Sonia and Chloe with her; on the way, Sonia explains that the patient has been "circling the drain" for six months but her family won't let her give up. Mrs. Borghouse greets them by actually throwing her food at them as they enter. Veronica and Sonia dodge, but Chloe's patterned smock receives an additional pattern. The patient says she can't eat the food, she's in pain, and she thinks she has a bedsore. She asks rhetorically what the nurses are "good for," and Veronica responds: "Well, we do try to keep the doctors from killing you"--an echo of the embolism plotline.
Later, the ED physician Harris introduces Veronica to a new surgeon named Chris Sands, and asks her to "tag along" with Sands as he visits Borghouse. This once again sets Harris up as Veronica's boss. Sands is the hunky, sensitive trauma surgeon with whom Veronica hooked up while serving in Iraq, and upon his release from service, he has actually followed her to this hospital in an effort at happily ever after. Sands has a pre-operative meeting with Borghouse, who is with her grown children. Sands asks if the patient has any questions. No one speaks, but Veronica interjects that it might be helpful to know the goal of the surgery; since the cancer has spread to her other organs, what are they hoping to gain? The woman's daughter says, "hope." Sands admits that Veronica's question is a good one, but says they are trying to buy her some more time. Veronica wonders how much time; will there be more chemo? Sands admits that there may be. The patient looks very unhappy, but she looks at her children, and then says, "fine." It's not a big mystery why Borghouse might be so difficult to deal with.
Outside, Veronica tells Sands that the woman seems to be going forward for her children's sake rather than because she really wants a pointless surgery, which will of course cause great suffering. Sands tells her, reasonably, that he has to take the patient at face value, so if she wants to fight, he fights; he treats the disease. Veronica responds that she treats the patient, which does point up for the public a basic difference in the nursing and medical care models, speaking generally. It's unusual for 8 million people to be told this in a compelling way, and however hokey it may sound, the show deserves credit for it. Then Sands pulls Veronica into a hospital storage room for a long passionate kiss. They catch up a little, though it goes no further than the kiss. As she leaves, she reiterates to Sands that he is selling "snake oil" to the cancer patient.
Later, we see Veronica bring Borghouse her meds. Borghouse is typically obnoxious, telling Veronica that the two men in her life (the perceptive Borghouse has had a chance to see that both are interested) will not fix whatever is wrong with Veronica. Veronica tells her to just swallow the drugs. But as she is about to leave, Borghouse stops her:
Borghouse: Do you think I should have this surgery?
Veronica returns from the doorway to sit beside her, and actually begins filing Borghouse's nails as she talks, which also means she is holding the patient's hand.
Veronica: You know, if you were my mother, I would say...no, it's too risky and it probably won't work.
Borghouse: I'm dying.
Veronica (looking at her): Yeah. Yeah, you are. There are a couple things that scare me about this surgery. You could die on the operating table. At least that would be painless. Or...you could die in recovery, in pain and on a ventilator, and that scares me. I think that you need to decide on the quality of time that you have left. And I'm...I'm scaring the hell out of you right now which is why it's become very clear to me I am in the wrong line of work.
Borghouse: No. You're the only person who's been honest with me. People treat you like an imbecile when you're sick.
Veronica: If you want to stop treatment, all you have to do is say so. Your kids will understand.
Borghouse: I think I'd like to be alone, if that's all right. ... Veronica, you're a wonderful nurse. Don't doubt it for a second.
Later, we see Sands emerge from the patient's room and tell Veronica, without anger, that the patient has canceled the surgery. Seeing her look and guessing what happened, he adds, somewhat amused, "but I'm taking it that you already knew that."
On the whole this plotline is a surprisingly good illustration of nurses' patient advocacy. It also captures a sadly common dynamic between nurses and physicians regarding end-of-life care that has occasionally appeared in the news media but very rarely been conveyed by Hollywood. NBC's ER was actually more likely to present the wise physicians as needing to convince nurses to let terminal patients go. It's important to note also that not all real-life physicians are as receptive as the Sands character to this kind of input.
Another plotline involves Sonia's care for another young gunshot victim, a very aggressive one, who seems to be involved in the drug trade. Somewhat ridiculously, she checks in on this patient while wearing fancy evening wear, on her way to go into Manhattan for a party with the wealthy lawyer. Suddenly, even though the patient is handcuffed, he assaults her, ripping her dress and giving her a swollen eye. She fights back hard, and others restrain the patient, but the damage is done. She angrily refuses the cop's offer of help, noting that her brother is also involved in the drug trade, blaming the cop, blaming the neighborhood, obviously feeling like she can't escape. She decides she can't go to the party in the state she's in. This is actually a good example of something that happens to nurses a lot: being assaulted. The show gets credit for showing it, and for taking it somewhat more seriously than a similar summer 2009 plotline on Nurse Jackie, in which Jackie simply shrugged off a pretty strong punch from a patient.
In the nurses' scenes outside of the hospital, there is a lot of drinking and fighting and yearning. The episode actually ends with all three female leads converging on a slightly injured but very attractive bartender (Chloe: "Don't worry...we're nurses!"). That's kind of flirting with danger, given the naughty nurse stereotype, and one promotion NBC runs for the show is worse, as it informs us that "these nurses make house calls...and office calls....and actually every kind of call," at the end showing Veronica's first hospital kiss with Sands. But although the nurses are obviously interested in men, they are not presented as "skanky syph nurses," to borrow the immortal Grey's Anatomy phraseology. A better NBC ad tells us that "some nurses give shots...Veronica calls them."
In any case, it's not hard to see the nurses as blue-collar strivers, "bridge-and-tunnel" women who dream of physicians and lawyers, but may have to settle. One female media critic suggested that the show is a step backward from ER because the nurses seem so desperate, and because they do not aspire to be physicians, as smart modern women must. Chloe's masters degree obviously didn't do it for that critic.
More basically, the show has attracted more contempt than it deserves from critics who seem tired of what they see as a glut of nurse shows with smart nurses pushing back against flawed physicians (just as the critics quickly tired of the roughly 279 Hollywood shows that have featured brilliant physicians ordering dim nurses around over the last 50 years). It seems that many people can't take too much narrative that runs counter to their deeply-held assumptions.
Despite its flaws, Mercy actually does have something valuable to tell the world about nurses--that they are skilled, intelligent patient advocates who save lives but often don't get the respect they deserve. We urge nurses to watch Mercy (the premiere is at the NBC site and free on iTunes), and use the show to help people think about nursing.