dr. vegas (2004)
Starring Rob Lowe, Joe Pantoliano, Sarah Lancaster, Tom Sizemore, Amy Adams
Executive Producers: Jack Orman, Steve Pearlman, John Herzfeld, Lawrence Bennett, Marc Sender, Kevin Brown
Produced by CBS Productions and Warner Bros. Television
The lightweight "dr. vegas" was an effort by "ER" veteran Jack Orman and other producers to bring some of "ER"’s apparent medical realism and soap opera elements to a flashy drama about a Las Vegas casino house physician with a gambling problem. This was Billy Grant, played by Rob Lowe. Even with some talent on both sides of the camera, the show’s writing was not strong enough to overcome the ludicrousness of its central premise, and it lasted just five episodes. It did offer one of the few significant network portrayals of an advanced practice nurse in Grant’s sidekick, nurse practitioner (NP) Alice Doherty (the capable Amy Adams). Sadly, despite a few instances of patient advocacy by Doherty, the show generally conformed to standard Hollywood stereotypes: the nurse as a skilled physician assistant who has no autonomous responsibility for patients and gets little credit for patient outcomes, but who is romantically available to physicians and patients alike.
Doherty was not one of the show’s lead characters. The main dynamic was the double-edged relationship between Grant and his friend Tommy Canterna (Joe Pantoliano), the street-wise casino manager. Like many network shows, "dr. vegas" did not suggest that nurses are simple sex objects or unskilled angels. It was more sophisticated than that. Doherty was supposedly an NP, but she had no patients of her own and little apparent autonomy. Grant consistently took the lead in health care interactions at their casino clinic. Adams helped Grant, calling out vital signs, supplying equipment and so on; she was, as he once put it, "my nurse." Adams did almost nothing on her own—and when she did, she got in big trouble. Grant typically received the credit for patient outcomes, such as saving the life of a drowning child in the third episode.
At several points during the show’s short run, Doherty showed some health knowledge, initiative and willingness to challenge Grant in caring for patients at the clinic. On occasion, she pushed for more holistic care. In one episode, Grant and Doherty treated the alcoholic, abusive father of the show's "beautiful blackjack dealer" character. Grant aimed to treat the unlikable father’s minor wounds and cut him loose. Doherty argued that Grant owed him a full court press for alcoholic rehabilitation, including detox and counseling. She prevailed, though the whole thing was phrased in terms of what Grant should do, when in reality, a staff nurse would do virtually all of it--to say nothing of an NP with extensive prescription rights. And it was Grant who stayed with the patient 24/7 during the detox at the clinic, a laughably inaccurate vision.
A common problem with the modern Hollywood depiction of nursing is the romantic element, and here "dr. vegas" was a major offender. Adams had a big crush on Grant, and at the end of the third episode, she initiated a seduction and slept with him. Of course, the show would probably have done the same thing had both characters been physicians. But the cursory way in which the plotline developed, and the fact that the nurse was initiating it, played into the stereotype that nurses' main interest in the workplace is to become romantically involved with male physicians. That’s pretty standard.
However, this episode also indulged in a plot device that respected Hollywood shows have been reluctant to use in recent years: the suggestion that nurses are romantically available to patients, and that this may even be a component of patients' therapeutic program. Here, the dying patient flirted with Adams, suggesting that a date with her would help him cross an item off his to-do-before-dying list. This could probably have been salvaged had Adams firmly declined the patient's offer, but they actually had a dinner date, followed by unresolved innuendo from Grant about how far Adams might have gone with the patient. The nurse-as-patient-escort theme was enhanced by the fact that the hacking, emaciated patient could not be considered especially physically attractive by Hollywood standards. Adams was providing escort services because that's what a good nurse does for a dying patient.
The final episode aired delivered a remarkably direct attack on NP competence and autonomy. Here, Grant rescued Doherty from a mistake brought on by her inability to handle her unrequited love for...Dr. Grant. In this episode, casino manager Canterna explained to an old friend's ne'er-do-well son that Doherty's NP status meant she got to "play doctor." The expected innuendo followed, and consistent with the "ER" model, Doherty had no real comeback.
But the episode's main plot revealed what the show meant by "playing doctor." Doherty, struggling to handle her feelings for Grant, got drunk with the ne'er-do-well, then, when he injured himself on the casino dance floor, brought him back to the clinic. There, she forged Grant's signature on an OxyContin prescription. Meanwhile, her date was stealing the prescription pad, resulting in keen interest from the police, especially when a hotel guest later OD'd and almost died. Grant saved the day by telling the police that he had authorized Doherty to write the prescription. The episode gave viewers the impression that NP's like Doherty cannot prescribe narcotics like OxyContin (in fact, Nevada NP's are authorized to prescribe DEA Schedule II substances). More importantly, the episode was a takedown of NP autonomy. Anyone can make a mistake, but it's hard to get around the vision of the irresponsible NP, that flighty female who can't handle her failed romance or her liquor, and needless to say can't be trusted with the awful power of the prescription pad. Of course, this damsel must be rescued by none other than the heroic physician whose liberty and license she has imperiled.
At the end of the episode, the Doherty character quit her job at the clinic, unable to work with Grant because she loved him so much, and it appeared that she was off the show. A few days after the episode aired, the show itself was put on hiatus, from which it never returned. "My nurses" have little reason to mourn.
Reviewed by Harry Jacobs Summers
Nursing Editor: Sandy Summers, MSN, MPH, RN
Last updated: March 4, 2005
The views expressed herein do not necessarily reflect those of the Board Members or Advisory Panel of The Truth About Nursing.