July 17, 2011 -- Recent press reports show that nurses saving lives outside of the clinical setting is news, but if there is a physician there, the nurses will likely be presented as the physician's assistants regardless of what actually happened. Today, the Raleigh (NC) area television affiliate WRAL posted a fairly good item by Ken Smith reporting that a nurse driving down a local highway had helped to save the life of a police officer who had been gravely injured when a truck struck his motorcycle. The nurse, who is quoted, reportedly directed others to make tourniquets and made sure the officer's airway remained clear. But news items about another recent save are more problematic. On June 29, the Sun Journal (Lewiston, ME) reported that a man had had a heart attack while attending a lecture about heart problems at a local hospital. Daniel Hartill's piece at least credits not only the cardiologist giving the lecture with saving the man, but also several named nurses in the audience, who--based on the report--seem to have done all of the actual saving, including defibrillation, without much input from the physician. The piece does get extensive quotes from the physician and none from the nurses, and it offers a dumb Charlie's Angels-style photo suggesting that the nurses were the physician's sidekicks. The June 29 MSNBC item based on the incident was not even that subtle, leading with a headline that included the phrase "Maine cardiologist saves the audience member's life," though the piece did at least note that a "team of nurses" was part of the effort. The June 30 National Public Radio item about the incident said that the patient "was surrounded by cardiac nurses who grabbed a defibrillator and saved his life," but the item also claimed that "Dr. Phillips oversaw the rescue." An Associated Press item, which ran in The Washington Post on June 29, credited the cardiologist and the "team of nurses" and even mentioned that a nurse did the defibrillation, though again it quoted only the physician. Perhaps it's natural that the person giving the heart lecture would get more credit than those in the audience, but no piece quotes any of the nurses, and only the local piece even names them. Overall, these reports show how media assumptions work to reinforce the impression that nurses are at best physician assistants.
He needed me
The WRAL piece about the motorcycle accident has a good headline, "Virginia nurse helps save injured Cary officer," which suggests that she helped to save his life. Based on the report (which includes video), that seems likely to have been the case. The item reports that nurse Jessica Elliot was driving on a North Carolina highway when she saw a pickup truck strike Senior Officer Chad Penland's motorcycle and send the officer flying through the air. The piece says that Elliott's "training as a registered nurse quickly kicked in." Actually, it's amazing how often pieces about saves by nurses in the field say something about their training "kicking in," often in a quote by the nurses themselves, as if their training was some kind of machine, separate from the nurses themselves. Would a physician ever be seen as so disassociated from her own expertise?
There are good quotes here from Elliot:
When I saw what happened to the gentleman, I did not expect him to be alive. There was no walking away from that. I mean, he needed me. . . . His biggest problem was he couldn't breathe very well, with his jaw dislocated and disconnected. He didn't have much of an airway, so I was holding his head in a way that he could breathe.
The piece says that Elliot "took command of the situation," "direct[ing] other people to make their shirts into tourniquets," while she "concentrat[ed] on Penland's most urgent needs." She also said that emergency medical workers soon took Penland, who was in a lot of pain, to Duke University Hospital. The piece reports that he suffered broken bones but is expected to recover. The pickup driver was "charged with failing to yield the right of way." The piece says (twice) that Elliot believes God put her there to help the officer, and it concludes by reporting that she feels "helping save the officer's life gives meaning to all the medical training she's had."
This is generally a good portrait of a nurse using her expertise to save, or at least help save, the life of a police officer. The reporter actually asks the nurse what happened, and she tells him, in a way that shows both her poise and how she used her skills. She triaged, determining that the officer needed a clear airway and making sure he had it, and she asked bystanders to make tourniquets from their clothes, which suggests both leadership and a pragmatic use of available resources. The references to God don't suggest that Elliot is herself some kind of angel; many health workers might feel there was some divine reason for them to happen upon a scene like this one. And the final sentence of the article reminds readers that it was Elliott's "training" that enabled her to help "save" the officer's life.
The national media articles about the man who had a heart attack during a heart disease lecture seem to be based on Daniel Hartill's report in the Sun Journal. That piece, "Heart lecture interrupted by heart attack," is based on extensive quotes by the man giving the lecture, Dr. William Phillips, and the report is built completely on his perspective. The piece does say near the beginning that "the cardiologist and nearby nurses saved the man's life." Apparently more than 100 people had gathered in a conference room next to the Central Maine Medical Center to hear an evening lecture comparing bypass surgery and stenting for heart patients. Phillips says they were discussing angina when a man raised his hand and said he was having it right then. The piece says "that's when Phillips got serious."
"I said to one of the nurses, 'Could you get a wheelchair and take him over to the emergency room?'" Phillips said. There wasn't time, though. The man collapsed and Phillips ran to his side. "In the meantime, he had completely arrested," the doctor said. "He had no pulse. He wasn't breathing. We started CPR and everybody's standing around." Three cardiac rehab nurses -- Brenda Robitaille, Nicola Adams and Heidi Langois -- were there, too. "It wasn't just me," Phillips said. "If I had been alone, it would have been terrible." One of the nurses brought in an automated external defibrillator, a portable electronic device that diagnoses a sudden, life-threatening heart problem and shocks the heart back into rhythm. "The AED saved his life," Phillips said.
Phillips reported that paramedics arrived, started an IV, gave the patient an EKG, and took him to the ED. Phillips says everyone wanted to continue with the lecture, so he did. Later, Phillips checked on the patient in the ED, where he was reportedly sitting up and talking.
Phillips admits that he was really hoping the man would recover "because, I thought, nothing could be worse if he dies right here"--presumably meaning because it would look bad. We admire Phillips' candor. Phillips stresses that the event illustrates, for the many heart patients who were present and for anyone who hears of the incident, the importance of a quick response to heart problems. He asked: "What if the man had been driving himself to the hospital?"
An important part of this report is Russ Dillingham's photo of Phillips and the three nurses. The photo shows the three nurses, surrounding the smiling physician, holding their index fingers up like guns and pretending to blow smoke away from the barrels. The caption notes that the
cardiac rehabilitation nurses do their "Charlie's Angels" impression Tuesday afternoon with Dr. William Phillips outside the Lewiston hospital. . . . Thanks to the quick action by Phillips and the nurses, the patient survived and is resting comfortably at CMMC. From left are Brenda Robitaille, Nicola Adams and Heidi Langlois.
To Phillips' credit, he makes a point of crediting others, particularly the nurses, and the Sun Journal's reporter and photographer permit him to do so. Phillips even concedes that it would have been "terrible" had he been alone. The nurses are named and photographed, they share credit for starting CPR and saving the man's life, and we hear that they brought in the AED (though Phillips oddly credits the machine alone for saving the man). Despite these elements, it appears that the journalists see Phillips as the leader of the rescue effort and the only one who needs to be consulted. The photo, with the nurses as "angels" surrounding Phillips, reflects this approach. Certainly, Charlie's Angels are far from helpless, but they do take orders from a more powerful man, and in this image they are sidekicks. Had any of the nurses been quoted in the article, we might have learned more about what they did for the patient. Still, at least they were not erased from the picture, and we give those responsible for the piece credit for that.
Overseeing the rescue
Some of the national pieces based on the Sun Journal's heart attack report seem to understate the nurses' roles more dramatically. The MSNBC item's headline is:
Man's heart attack interrupts heart disease class
Maine cardiologist saves the audience member's life -- and then continues the lecture
Obviously, it's easier to compress the whole team into the physician for the headline; easier, but inaccurate and damaging. The MSNBC story then gives the basic account of what happened from the Sun Journal, clarifying that Phillips, "along with a team of nurses, saved the life of" the heart attack victim. After the man collapsed, we read, "the doctor and the cardiac rehab nurses who had been attending the lecture began CPR on the patient, as another nurse ran for a portable defibrillator. The quick reactions of the group saved the man's life, according to the Sun Journal." That's all pretty good, but only Phillips is named or quoted.
The Associated Press item about the incident, as run in the Washington Post, actually credits the nurses in the headline:
Cardiologist, nurses save man having heart attack during Maine lecture on heart disease
And once again, the nurses get some "team" credit in the body of the piece, which says that a "Maine cardiologist and a team of nurses are being credited with saving the life of a heart attack victim." The basic scene is described this way:
Phillips asked a nurse to take the patient to the emergency room, but he collapsed. The victim wasn't breathing and had no pulse. One of three cardiac nurses grabbed a defibrillator to help restart the man's heart. Meanwhile, paramedics arrived and took the patient to the emergency room.
That's a fair summary of the Sun Journal's account. But only Phillips is named or quoted. Incidentally, the AP item is the only one of the national pieces we saw that even mentions the paramedics, and even the AP only has them arriving and transporting the patient, a significant understatement of their skills and critical role in saving patients in the field.
NPR's basic account of the incident, as delivered by Morning Edition host Steve Inskeep, gives the same basic account of the incident. However, NPR adds a critical bit of interpretation:
But the man's timing was perfect. He was surrounded by cardiac nurses who grabbed a defibrillator and saved his life. Dr. Phillips oversaw the rescue and resumed his lecture.
We like the "saved his life" part, but where did "oversaw the rescue" come from? It's not explicitly stated in the Sun Journal piece. Of course, it is suggested by that piece's text and photo, and it's an easy jump to the assumption that the physician must have "overseen" the nurses. After all, supervising nurses is part of what physicians do, right? Everyone knows that! Except that it's wrong. Nurses are autonomous professionals with distinct life-saving skills, and they do not report to physicians. And nothing in the Sun Journal account suggests to us that the nurses needed Phillips there; in fact, the only specific care intervention we see attributed to him was his request that the nurses wheel the patient to the ED, which turned out to be futile.
On the whole, these pieces suggest that the media may notice when nurses play a role in saving lives outside normal clinical settings, but that if a physician is present, the story is likely to be mainly about the physician, regardless of the apparent facts. Of course, in traditional clinical settings, where the media thinks it understands the structure of care and the roles of health workers, the assumption that physicians are the only ones who matter is far stronger. If nothing else, we hope that reports about unusual saves like these do suggest to members of the public that nursing might be more important than they thought, even in everyday care settings.
See Daniel Hartill's report in the Sun Journal "Heart lecture interrupted by heart attack" from June 29, 2011. You can contact the author at email@example.com.
See the MSNBC story "Man's heart attack interrupts heart disease class: Maine cardiologist saves the audience member's life -- and then continues the lecture" from June 29, 2011.
See the Associated Press story "Cardiologist, nurses save man having heart attack during Maine lecture on heart disease" posted June 29, 2011.
See and hear the National Public Radio (NPR) story from June 30, 2011 "Man Times His Heart Attack Perfectly."