Fiddling with the covers while Rome burns

 
December 8, 2009 -- Tonight's episode of ABC's Scrubs offered a great example of how poor the show's portrayal of nursing has become after the departure of the sole major nurse character, Carla Espinosa, after the last season. It's true that the vast majority of the sitcom's clinical scenes have always depicted nurses as anonymous handmaidens to the physicians who provide virtually all the thinking and all of the important care. But Carla was a respected, competent person who at times conveyed health knowledge, on occasion even teaching the young physician characters. Now, with Carla's departure and the show's shift to a medical school setting for its ninth season, the few nurse appearances tend to be like tonight's, in which a mute, nameless nurse was no more than a wide-eyed prop during a code scene, waiting for the physicians to tell her to get a crash cart, fiddling with the patient's covers, and then scurrying out of the way so the physicians could save the patient by themselves. Of course Scrubs has probably spent more time making fun of physician characters than any other television show in history. But it has still managed to reinforce the core social assumption that physicians are the brilliant masters of all health care, and nurses are no more than their faithful helpers. Tonight's episode, "Our Role Models," was written by Steven Cragg and Brian Bradley, and directed by Gail Mancuso.

See the relevant film clip in Quicktime at broadband or dialup speed.

The episode is a fairly typical one from early in the ninth season, with senior attending Perry Cox and his disciple John Dorian (JD) as medical school professors. Cox teaches through terror, while JD tries to bond with the students, just as he has always wished Cox would bond with him. In one scene, Cox is leading a group of the students through a hospital unit when a patient begins coding. Cox calls on his favorite student, Drew (or as Cox refers to him, "Number One").

Cox:   Number One, jump in. (Then, to the other students.) Do you know why I call him Number One? It's because he is Roger and ready to do this stuff. Drew, run the code, what's first?

Drew:   I don't know.

Cox:   I'm standing right here next to you. Let's take his pulse. Now tell me, which nurse should go get the crash cart? He who hesitates is lost. Take a breath--make a decision.

A nurse has suddenly appeared right on the other side of the patient, and she seems to be taking the patient's pulse.

Drew:   Her! (Then, addressing the nurse.) Go get the crash cart!

The nurse meekly obeys, as if she would never have thought of getting the crash cart for a coding patient--thank God the physicians are Roger and ready to do these things! As the nurse runs for the cart, Drew starts compressions. But they don't seem to help.

Cox:   You're doing great.

Drew:   Is this guy dying?!

Perry:   Probably, but he's been circling the drain for months, so it's no biggie. Now, he's unresponsive to CPR, what's next?

Drew doesn't know and he freaks out, then leaves, telling Cox he's not ready for this. Cox calls for JD, who just happens to be nearby. JD is thrilled to help, and to curry favor with Cox.

Cox:   Newbie! Jump in here!

At this point the nurse seems to be doing nothing but straightening the blankets on the patient's bed while he is coding. JD practically pulls the nurse aside, but he doesn't really need to, as she seems eager to get out of the way of her betters, who know what to do in a code. The nurse immediately disappears. JD apparently does all the right stuff, though we don't really see it. The nurse has no name and has not said a word during the entire scene.

Of course, much of this scene is insane, but it's not good insane, or on-purpose insane, in the way the show's best comic bits are. In fact, the scene is pretty serious, and viewers will have no reason to question that it's a more or less realistic glimpse at how things might go if a senior physician tried to bring a medical student along too fast in a clinical setting.

In fact, though, nurses are not mindless go-fers who appear and disappear on the whim of physicians. Nurses are the ones who monitor patients, they call and respond first to codes, and they do not need physicians to tell them to get crash carts. They do not, or should not, scurry meekly out of the way of physicians during a code. Nurses have their own distinct roles to play in saving a patient's life, and it's actually more likely that a nurse would need to ask a physician to move aside so the nurse could play those roles. And of course, it's extremely unlikely that a nurse would spend her time straightening a patient's covers while he is coding, essentially fidgeting as she waits for a physician to tell her what to do, or to simply pull her out of the way so he can do something. We must say, though, that the fix-the-covers idea was a minor classic in the annals of anti-nurse television.

In the rest of the clinical scenes, nurses play virtually no role, and physicians provide all the care that matters, including all psychosocial care. Of course the show is irreverent and fatasy-oriented, but it has some serious underlying themes, and it does distinguish between fantasy and reality. It is a problem that the show's nurses are meek, brainless lackeys awaiting physician commands.

Carla used to make such scenes less intolerable. She did not appear in that many clinical scenes, and the show did periodically indicate that she reported to the physicians. But she did at least have a brain, and in general she was not afraid to use it, at times displaying knowledge of patient conditions, playing a role in saving patients, and even doing informal teaching of new physicians like JD. She was married to surgeon Turk and also a good friend of Cox's, and much of the time she seemed like their peers.

But we understand that show creator Bill Lawrence has said he did not know how to incorporate a nurse character into a show whose main setting was a medical school. Evidently, his advisors forgot to tell him that nurses (thousands of whom have PhD's) do sometimes teach courses to medical students.

Well, they do after they've made sure that their patients' covers are under control.

Please send your comments about Scrubs in care of the show's publicists Makena Coscarelli and Amber Gereghty at Makena.Coscarelli@abc.com and Amber.K.Gereghty@abc.com. Please copy us on your message at letters@truthaboutnursing.org. Thank you!

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