In the thick of it
September 30, 2009 -- Tonight's episode of NBC's Mercy included two plotlines that highlighted strong, innovative patient advocacy by lead character Veronica Callahan and novice nurse Chloe Payne. In one plotline, Veronica fights through abuse from an injured patient who is furious that his leg, shredded in an accident, has been amputated without his knowledge. Veronica brings the patient some closure by retrieving the leg from the hospital's bio-waste department and bringing it to him so he can say goodbye. Meanwhile, Chloe helps a patient who seems like no more than a manipulative drug addict, despite mockery from other nurses and skepticism from physician Dan Harris. This patient claims that a pounding in the ears has driven him to his OxyContin addiction. Chloe determines that the pounding is real, and caused by a blood vessel about to burst, simply by applying her stethoscope to his external ear, which evidently no one else thought to do. These plotlines have some silly elements, but they both show the episode's 7.4 million U.S. viewers that nurses' job is, as Veronica actually tells Chloe, to advocate for their patients. The episode is show creator Liz Heldens's "I Believe You Conrad."
In one plotline, a young man named Phil has hurt his leg badly in some stunt involving rolling along the street at a high speed, then crashing. He lies in a hospital bed surrounded by his somewhat rowdy friends, as Veronica and physician Chris Sands enter. Sands says Phil's leg has significant muscle, artery, and nerve damage, and it's not clear he can re-establish full perfusion. But he has trouble getting Phil and his friends to focus because, as Phil himself notes, he is high from his drip and his friends took Valium in the waiting room. Translating for this impaired group, Sands explains that Phil "shredded" his leg and will have to stay in the hospital a while. Sands leaves, and they all notice Veronica.
Phil: What up, sexy nurse?
Phil's friend grabs Veronica's butt.
V (pulling his hand off): Hey! Not funny or cute. Get out--everybody.
They don't like that, but they go.
Phil: Can I at least get a sponge bath?
Veronica calls in a large male nursing assistant to do the bath.
This scene has a casual quality, and there is no sense that Veronica ever loses control of the situation, but sexual abuse from impaired patients is a real problem for nurses, as recent news reports confirm. Such abuse should not be seen as just part of the job, however expertly a nurse like Veronica might deflect it.
Later, a bored Phil sends his girlfriend for magazines. Then he tells Veronica, "She's gonna be gone for at least 20 minutes, so there's time for you and me." Veronica tells him that his girlfriend will walk if he is not nice to her. Phil asks where she would go. Veronica says she married a guy like him, and the arrested development thing gets old. Phil rightly notes that she is still married. They call each other idiots.
But as they are having this exchange, Veronica determines that Phil has a fever, and she also sees that he does not look so great. She asks if he is OK. Phil says he feels a little woozy, and that his foot is cold. She looks at it, then asks if it's numb. He says maybe a little, then weakly requests water, and promptly passes out. Veronica calls for help.
The next thing we see is Veronica and Chris Sands with Phil, who is waking up in his bed. Sands gently explains to Phil that he passed out, and they took him to surgery, trying to re-establish blood flow in his leg, but they could not. Sands says they had no choice but to remove Phil's leg below the knee, or else he would have died. Phil sees this is true and freaks out, asking what they did, and what they did with his leg. Later, Veronica tries to interest Phil in physical therapy. But he is despondent.
Veronica: Listen. I served in Iraq, I saw a lot of guys who lost limbs. This is not a game ender. Especially since you still have your knee.
Phil: I can't even look at that ugly stump.
Veronica: I'll look at it. Let's look at it together.
Phil: No. Don't touch me. ... Where is my leg?
Veronica: Excuse me?
Phil: My leg. Where is it? You guys just took it. And nobody asked me.
Veronica: Is that what this is about?
Phil: I don't want you in here. You don't like me, I don't like you, I don't want to hear your stories about Iraq or whatever, I just want to be alone. (Smashing at his food stand, very close to her.) Will you get out of here, please? Just leave.
Veronica does leave, somewhat taken aback by this near-assault, but she never stops thinking. She goes to the bio-waste department, somewhere in the depths of the hospital, dragging along Chloe, who wants advice about her own patient. Veronica tells Hector, the staffer at the bio-waste department, that she wants to find Phil's leg because "this kid didn't get to say goodbye, he needs, you know...closure." Hector resists, saying it seems unsanitary, "and I don't believe in closure."
Veronica: OK, well, thank you...for your opinion, but...I need the leg.
Hector relents, and they both look for the leg. Veronica rejects Hector's efforts to get rid of her by giving her a black person's leg (Phil is white), and she continues to root around the room full of body parts in plastic bags until she finds it. Later, we see Phil looking at the leg Veronica has brought him in its plastic bag.
Phil: You are one hard-core crazy bitch.
Veronica: You said you wanted to see it.
Phil: I said that in a fit of rage and sadness. What is the matter with you?
But he leans up to look at the leg.
Veronica: That leg is just skin and bone, you know? It helped you, but then it had to come off. It would've killed you.
Phil lies back down and sighs.
Veronica (briefly touching his chest and head): You're here and here. You're still you. It's gonna be OK, I know it doesn't seem like it, but it is.
Phil: I'm still an idiot.
Veronica: A little bit, yeah....yeah. Let's look at your leg now. Ready?
She moves the sheet aside to reveal his leg.
Phil: The stump...I have a stump.
Veronica: I prefer the term nub. ... This is your body. It still works. You just have to get used to it. The prosthetics are crazy now. There's some seriously bionic stuff out there.
Phil: Can I keep my leg?
Veronica: Because it's gross, and it smells bad.
Phil: Well, what are you gonna do with it?
Veronica brings Phil down to what looks like an incinerator, apparently so he can have control over how the leg is disposed of, and they look into the fire as they speak.
Veronica: Would you like to say a few words?
This sounds like a joke, but he doesn't exactly take it that way.
Phil: Left leg...the first time I remember thinking about you was when Todd hit you with that dart. That hurt. So we kicked him in the balls! I remember, like, climbin' trees, runnin' away from cops. Wearin' flip flops. You were a good leg....really good. I wish I hadn't done that stupid thing the other day, but, I did, and I'm sorry, I wasn't taking care of you. It's hard. (To Veronica.) You know that phantom pain thing? When you feel pain in your leg even though you don't have a leg? I don't like that idea, that freaks me out. I'd like to be able to just...say goodbye now, and have that be the end of it. Do you think that's a possibility?
Veronica: Yes. Yes, I do.
He moves to throw the leg in the incinerator, but Veronica stops him, explaining that it has to go back to bio-waste. She says this was just a "symbolic gesture," the leg gets trucked out of there, since there are "zoning laws about burning human flesh in cities."
Phil: Right, because the smoke gets in the clouds, and then it rains, and people become zombies.
Veronica: Yeah, that's totally why.
Some elements of this plotline may be unlikely, but it is an extraordinary illustration of nurses' roles as patient advocates and managers of patients' overall well-being. Veronica sees that Phil's depression will impede his recovery. So she persistently works around his abuse and generally obnoxious demeanor, using whatever thinks might get to her patient: humor, bluntness, personal revelation, and ultimately an innovative measure that even Phil finds "crazy"--but that is clearly very effective in bringing him some of the closure he needs. This is not something just anyone could do or would think to do; it requires a great deal of strength and psychosocial skill. And although other prime time broadcast dramas like Fox's House and ABC's Grey's Anatomy show only physicians doing this kind of thing, here it is the nurse--the one who would likely do it in real life.
In another major plotline, we see nurse Chloe approach her patient Conrad Bellingham, who was in a car accident and now lies in a hospital bed. Conrad reports that he is in a great deal of pain. Chloe says she'll speak to his physician, who will be there in an hour. This does not seem to be soon enough, so Conrad asks her to ask the EMTs for his bag, which he says has his iPod. Chloe brings the bag and Conrad scoots to the bathroom with it, just as physician Dan Harris enters. Harris says the toxicity screen showed Conrad was full of OxyContin when he "wrapped his car around a tree," so he is a drug addict and will get no morphine. Harris asks where Conrad is, and they figure he must be taking more drugs in the bathroom. Two white-clad orderlies suddenly appear (apparently on loan from some movie about a psychiatric institution) to break into the bathroom and haul Conrad out.
The plotline's handling of the medication issue seems undeveloped. Even if Conrad is an addict, shouldn't Chloe insist that they do some analysis of what is supposedly causing him pain? Even addicts get medication if they have pain caused by injuries sustained in a car crash. Of course, it does eventually appear that Conrad's pain has a different source.
Chloe gets some mocking from the other nurses for being so gullible, and she later confronts Conrad, upset that he deceived her. He says he is taking the OxyContin to help him endure "a persistent ringing in my ear." Chloe is skeptical. He confesses that his addiction has destroyed his life; he used to teach Russian literature at a college. She suggests seeing a physician. He says he has, but the physicians say it's nothing.
Conrad: It's not nothing. It's torture. It's the sound of gravel being rubbed together, it's like a metal trash can being dragged down the street. Please, you have to help me.
Chloe consults Veronica (a new nurse consulting an experienced nurse! Nurses become more expert over time, just like physicians!). Veronica takes Chloe along on her mission to the bio-waste area. Chloe says she believes Conrad, and wonders if he might have Ménière's disease, or a brain tumor. Chloe says she wants to run more tests, but everyone thinks Conrad's a drug addict and she's a dingbat--how far is she supposed to go to help a patient? Veronica responds while holding a body part in a plastic bag.
Veronica: Look what I'm doing right now. Your job is to advocate for your patient. If you think he's sick, he's probably sick. You gotta go with your gut. Unfortunately, your gut is from Lancaster, Pennsylvania, so I don't really know what to say...about that. Hey, here it is! Found my leg! Look at that. (To Chloe.) Oh, cheer up. You're in the thick of it. It's a good thing. Convince Harris to run the tests. Just, you know, work him a little, flirt with him a little. Use your feminine ways. Unless that's not your...cup of tea.
Of course, nurses should not have to "flirt" to get what patients need, but it would be foolish to claim that does not occur. It certainly is an interesting variation on the naughty nurse--as patient advocate! Be that as it may, the episode tells million of viewers that nurses' job is to advocate for their patients, and that is not something we see very often.
Later, we see Harris report that the MRI screen for Ménière's came back negative, and says with some satisfaction that they'll be releasing Conrad. Evidently Chloe at least got him to run tests. Chloe will not give up.
Chloe: I read online about this vestibular evoked myogenic potential testing.
Harris: No, no, we're done here. It's a side effect of abusing OxyContin. When you hear hoofbeats, think horses, not zebras. (To Conrad.) It's simple: Lay off the drugs and I'm sure you'll see an improvement.
Harris wants to speak with Chloe outside.
Harris: Chloe, you're going to have to use better judgment. You're going to be an easy mark for every unsavory character looking for sympathy.
Conrad appears in the hall with a knife.
Conrad: I swear to God I'll cut my ear off if you don't give me that test. (No one moves.) I swear to God. Nothing? Nothing, seriously, no one? I'm gonna do it, fine. Here I go...Ow. Ow. What is wrong with you people? Why is no one stopping--
And the two ridiculous white orderlies tackle him. Later, Chloe is giving the now-restrained Conrad a drink, and he starts to cry, because he can't take the sound. He says it's killing him, and no one believes him.
Chloe: I believe you, Conrad.
Conrad: Yeah, well, that and a nickel...
Chloe moves her stethoscope to a place beside his ear and listens.
Chloe: I hear it. I hear it, Conrad.
Next, we see Chloe literally dragging a protesting Harris to come hear the sound.
Chloe (using her feminine ways): I just need your expert opinion. Dr. Harris, is that a new shirt?
Harris: Well, actually it is.
When Harris sees that it is about Conrad, he is not enthused. But Chloe asks him to wait, and she goes around Conrad's bed to a monitor she has hooked up.
Chloe: You can hear it on the fetal heart monitor, just listen. ... It's like the ocean.
Harris can hear it, and he puts his stethoscope to Conrad's ear.
Harris: Well. You have a blood vessel that's about to rupture, young man. I'm very glad that we got to the bottom of this.
Yes, thank goodness "we" did! But the episode pointedly has Conrad thank Chloe.
The Chloe plotline shows a nurse trying persistently to determine what is wrong with her patient, despite skepticism and even mockery from those around her. Chloe proposes possible diagnoses showing that she has technical knowledge, and apparently even manages to persuades Harris to run more tests. When she runs out of options, she simply applies her stethoscope to Conrad's head, trying to hear what he hears, to put herself in his place. However plausible all this may be, it shows Chloe, like her mentor Veronica, to be a determined patient advocate with critical-thinking skills. She does not give up.
We thank Liz Heldens and the others responsible for this helpful episode.
See Mercy Wednesdays at 8pm/7c on NBC or watch episodes online at nbc.com/mercy.
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