The Drunk and the Ugly

November 6, 2005 -- Tonight's episode of ABC's "Grey's Anatomy," seen by 19 million people, featured yet another anti-nurse slur from one of the show's pretty physician heroes. Hotshot intern Cristina Yang dismissed a veteran nurse from a patient's room with a comment that the physicians would let her know if a bedpan needed changing. Rather than objecting to this, the nurse took revenge by paging Yang to do a series of grotesque bodily fluid tasks. We realize that this fantasy about workplace roles was likely intended as a token effort to show nurses respect. But it still associates nursing with icky tasks that seem menial, wrongly suggests that physicians help with them, reinforces battleaxe stereotypes, and does nothing to show what nursing is really about. On the contrary, it is fully consistent with the show's vision of nurses as fawning or vindictive losers whose lives revolve around the physician characters who provide all meaningful care, including key tasks that nurses do in real life. The episode suggests that the problem with anti-nurse slurs is not that they're inaccurate, or ultimately a threat to public health. It's just, as one resident notes, "stupid" to "piss[] off the nurses"-- the petty little clean-up crew of health care. The episode, "Something to Talk About," was written by Stacy McKee. The medical consultant was Karen Lisa Pike, MD.

In one of the episode's subplots, Cristina "steals" an interesting case from the psychiatric ward. This male patient seems to have a hysterical pregnancy, though his huge belly mass ultimately turns out to be a teratoma that must be surgically removed. Cristina sneaks her surgical intern friends into the patient's room. An older nurse enters; we'll learn later that her name is Debbie, though of course the interns rarely trouble themselves to address nurses by name. Debbie says, somewhat crankily: "This room is supposed to be unoccupied. Whose patient is this?...Who transferred him? I don't have any paperwork, any transfer documents..." Cristina dismisses Debbie: "Give me a break. We shuffle rooms all the time. You know, if we need a bedpan changed, we'll let you know." Debbie retreats, but seems barely able to contain a smile as she says: "OK, doctor, you do that."

Later, Cristina is annoyed to be paged to the ward, which takes her away from the cool teratoma. When she arrives, Debbie piles a bunch of charts in front of her, saying: "Patient in 42, 43 needs a rectal. Then I've got two infected wounds, a Foley, a groin abscess, four debridements, and a case of explosive diarrhea." Cristina: "You're kidding me, right?" Debbie notes dryly: "I'm not known for my humor." Cristina says none of these are her patients, but Debbie informs her that if she is resident Miranda Bailey's intern (as she is), these are her patients. Later, nurse Tyler, who occasionally pops up on the show to gloat or act petulant, pages Cristina to clean up vomit. He says he "was told" to page her and only her if something like this came up. He won't say who said that, but Cristina comes to believe it was Bailey.

Finally, Cristina confronts Bailey about punishing her with these awful tasks, presumably because she "stole" the teratoma patient, wasting Cristina's time and effectively keeping her away from the teratoma surgery. Cristina complains that the nurses have been paging her all day. But it becomes clear that Bailey knows nothing about it. Nurse Debbie, standing nearby, observes: "A little bit of respect and you could have saved yourself a very long day, Dr. Yang." Cristina seems briefly surprised to learn that Debbie was behind the nasty tasks. Bailey remarks: "Pissing off the nurses...stupid." But neither Bailey nor Cristina says anything to Debbie. Instead, Cristina ignores Debbie and pursues Bailey down the hall to angle for a role in the surgery.

This "nurses-give-the-intern-scut-work" plotline reflects virtually no understanding of how hospitals work. Most of the things Debbie lists are tasks that nurses do and physicians have nothing to do with. Some are patient conditions or procedures that nurses would not present to physicians without explaining what they thought needed to be done. The scene is fundamentally absurd.

But there are larger problems. These include the incorrect suggestion that nurses assign junior physicians body fluid tasks as punishment, that these tasks are unimportant, and that physicians would actually help with the tasks, which most would likely consider beneath them (as Cristina does). In fact, many of the tasks the show is describing require skill and mental strength. Some provide opportunities for nurses to assess the patient's condition and to detect life-threatening changes. Wound care is a complex area in which nurses typically have far more expertise than physicians. But the show presents the tasks as nothing but the lowliest scut work. Thus, it both degrades nursing tasks that involve bodily fluids and wrongly suggests that physicians have the skills and willingness to be in the trenches helping out. It also suggests that health care worker roles can be switched around at will, like a Judy doll's clothes, with no regard for patient wellbeing or efficient care.

The plotline does nothing to counter Cristina's original suggestion that nursing is all about bedpans. On the contrary, it actually reinforces that idea by associating nurses so closely with such seemingly menial body fluid tasks. After all, pretty much all we see the nurses do here is dump such tasks on Cristina. Though the wall-to-wall physician characters do provide virtually all bedside care, the show does not generally tell viewers they have a role in these tasks. (The November 29 episode does suggest that the interns regularly give enemas; icky tasks seem to be a plot device that conveniently facilitates punishment or humiliation). The Debbie plotline suggests that nurses can't defend their profession on the merits, because what Cristina thinks about nurses and bedpans is essentially correct, give or take a few scenes in which Tyler or nurse Olivia play handmaid in some other respect. But Cristina should not actually point out the fact that nursing is a menial, subordinate job, or crones like Debbie will have their revenge, my pretty! It's true that the physician characters have their flaws. But they are brilliant, commanding life-savers, while the nurses are peripheral, usually mute assistants. And of course, there's no physician battleaxe stereotype. The rest of the episode is true to form. The physician characters persistently usurp the real nursing role, monitoring patients, giving drugs, and providing all psycho-social care, all patient advocacy and all patient education.

We realize that the plotline was a token effort to show nursing respect, perhaps even to make amends for the show's past attacks on nursing. You could see Debbie's actions as evidence of a mild wit--she gets Cristina with the same type of tasks Cristina has used to insult her. And maybe we're meant to like her expression of "nursing power." One apparent lesson for Cristina was that nurses actually have the power and inclination to take such revenge; she assumed only physicians like Bailey did. And maybe some viewers did not know that nurses knew words like "debridement."

But ultimately, Debbie's silly revenge teaches Cristina (and viewers) nothing about what nurses really do to improve patient outcomes, and carries instead all the damaging messages discussed above. Debbie might have been shown humiliating Cristina by catching an error and saving her patient's life, which would be very realistic. But Debbie's revenge here is that of a petty bureaucrat with no other weapons. Neither Bailey nor Cristina treats Debbie as a serious professional who deserves respect, rather than a potential obstacle to be negotiated. And Cristina will have the last laugh. We recall Winston Churchill's response to a woman who told him he was drunk, one version of which is:

"I may be drunk, Miss, but in the morning I will be sober, and you will still be ugly."

Cristina may have been a little drunk on ego and ambition. However, in the "morning" of future episodes, she will remain a pretty, esteemed surgeon, enjoying huge economic, social and moral rewards, perhaps a little more careful in how she treats nurses. And Debbie will still be a marginally skilled battleaxe who cleans up the mess.

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