Monday, August 5, 2024

ER & Grey's Anatomy Comparison & Analysis, Part 2: Cook County General Was A Poorer Hospital Than Seattle Grace But Its Physicians Had A Higher Standard of Care

 

In my introduction to this series I made it clear that ER was always medical drama and Grey’s Anatomy is a soap opera set in a hospital.  I was being too generous to Grey’s Anatomy on that score. Grey’s Anatomy is a soap opera set among the surgeons  who work at a hospital.

Now again I do acknowledge that I stopped watching Grey’s Anatomy on a regular basis at the end of Season 5 and only watched it sporadically until the end of the eighth season. So I may not entirely be accurate when it comes to making generalizations. So I’ll ask any of you who still watch Grey’s Anatomy who might prove me wrong: in the twenty seasons Grey’s has been on the air has their ever been a regular in the cast (by which I mean in the credits) who is not a surgeon? Who isn’t a surgical resident, studying surgery or doesn’t have experience in the OR?

Because for all the diversity we may see on Grey’s when it comes to racial, gender and sexual barriers being broken during the eight seasons I watched the show in a critical sense the cast was the most homogenous of any hospital drama I remember seeing, perhaps in TV history. I don’t remember ever seeing a single cast member who wasn’t either a surgeon or studying to be one.

Now I’ll grant you that Grey’s Anatomy does follow surgeons extensively. But there’s extensively and single mindedly. To explain, let me use ER as the key example.

From the pilot to the final episode ER never forgot that it was set in a hospital and that while the ER may have been the center of the action, it was not just a single set of doctors who made it tick. We saw ER attendings, starting with Mark Greene, ER residents, starting with Susan Lewis pediatricians, most famously Doug Ross, med students (John Carter) nurses, starting with Carol Hathaway, and surgeons, starting with Peter Benton. And as anyone who watched ER knows, those were merely the first cast. The cast members who lasting the entire series were nurses, male and female, orderlies and clerks. (The most famous was Jerry, played by Abraham Benrubi for the first five seasons and then on a recurring basis starting in Season Eight.)

We also saw that at Cook County there always going to be specialists called in and we saw quite a number of them almost from the start: psychiatrists, ob-gyns (Amy Aquino played the role throughout the series) cardiac surgeons and so on. Benton was a resident at the time so we constantly saw him interact most frequently with his surgical attendings, played most frequently in the early seasons by David Morgenstern (William H. Macy) and Angela Hicks (CCH Pounder). Morgenstern was the head of the ER for the first four seasons, in Season 3 Donald Anspaugh (the late John Aylward) took over as chief of staff. (I’m going to get back to both of these characters later on.) Later on, we met Jeannie Boulet (Gloria Reuben) who took on the ER position of physician assistant. We also met other members of the staff including oncologists, neurosurgeons and pathologists and there was frequently a vast array of social workers. We’d met some version of all of these characters by the time Season 1 of ER was finished and while we kept meeting new characters, we would also meet the occasional pharmaceutical rep, research specialists, virologists and other specialties.

By contrast over the first five seasons of Grey’s Anatomy you could have been forgiven for thinking the only people who had anything to do at Seattle Grace were surgeons, surgical residents, surgical teams and the chief of surgery. I’ll admit we would occasionally meet a nurse who stayed around for a few season, maybe an anesthesiologist or two, but they only seemed to be there either as love interests for the central characters (famously George developed syphilis in Season 1 from a nurse he’d been dating – who’d also been sleeping with Alex) or there for a brief storyline. Occasionally you’d get a guest star as a paramedic (Christina Ricci famously played one in Season 2) but as far as Shonda Rhimes was concerned, all of the surgeons and surgical residents were essentially doing all the work as Seattle Grace.

For all the times surgeons were called to the ER, I never remember seeing a single ER attending calling them, certainly none that was a character of note. Because there are apparently no physicians at Seattle Grace, they have no need for physician’s assistants, there are neonatal surgeons who apparently do all the work of ob-gyns, there are pediatric surgeons but no pediatricians, all the med students and interns are solely devoted to surgery and no other specialties, research entirely has to deal with surgery…well, I think I’ve made my point.

I don’t know if Rhimes or any of her fellow writers have made this as a deliberate choice over the years. Rhimes is certainly aware that there are other kinds of doctors besides surgeons; she made that very clear in the spinoff Private Practice and we saw a different contingent play out in Station 19. A large part of it seems to be the egotistical single-mindedness that surrounds every surgical resident I saw at the start of the show: it has been clear from the start that as far as Meredith Grey and her colleagues concerned, there is surgery and nothing else matters. But that doesn’t track either: three years earlier Scrubs debuted and from the start to the finish, it was clear that DJ and Turk knew very well that they couldn’t do their jobs without the other and as we all saw Turk famously married and had a family with Carla one of the nurses at Sacred Heart.

There’s also the unbridled arrogance we see among so many of the surgical interns from the start of their career that seems utterly unmerited based on the fact they admit their cluelessness at the start. It compares horribly with the story of Carter who spent much of the first season struggling to pick a specialty, decided to become a surgeon because of his bond with his resident Peter Benton but at the end of his first year he realizes he is not cut out for surgery and decides to go back to the ER. This is the hardest decision of his career and Benton needs a lot of time to forgive him for it. At the start of Season 4 the two are not speaking and Benton finally expresses his anger. He says he spent so much time with Carter – something he clearly hasn’t done with any med student in a long time – and he’s angry because Carter, when he was struggling with the decision, went to Anspaugh and not him. “I thought you’d talk me out of it,” Carter admits. “I wish I’d been given the chance,” Benton concedes.

None of the residents in Grey’s Anatomy – not the first five, not any that came after – ever had a scintilla of doubt that surgery was their calling. Even Christina’s period in the wilderness during Season 7 she considered leaving medicine if she couldn’t be a surgeon. And I have little doubt that had any of them had decided to shift their focus – as Stevens or O’Malley very well could have – Yang or Karev would have had no problem freezing them out for not being able to cut it.

We see this scorn throughout their residency: Meredith and Christina openly mock other specialties such as psych and dermatology as jokes and can barely be seen talking to anyone who isn’t a surgeon. And this goes all the way to the top; for all Miranda Bailey’s willingness to be human at the times, I never saw her interact with anyone in the hospital who isn’t connected to surgery and Richard Weber famously is willing to put surgeon’s salaries ahead of the nurse’s demands, which leads to a picket line. And Weber can only see making a hospital better through surgery: when Seattle Grace drops from 2nd to 12th in the medical rankings, he goes through a series of ‘improvements’ – but we only see them in surgery. That same episode the hospital floods when he spends that season ignoring the warnings from his staff, he purchases a new medical animatronic device for surgery, only to spend its first use making fun of O’Malley and he focuses so much energy on the first solo surgery he ignores the fact that the current set of interns have started operating on themselves – until one of them tries to remove their own appendix.

Cook County, it’s worth noting, is always underfunded, scrambling to deal with budget cuts and is always dealing with its share of bigger problems – power outages, contaminant leaks, custodial strikes and the endless chaos that just seems to come with being in an ER. But throughout the series run, you kept seeing all of these doctors as never being arrogant, always being compassionate and always trying to adapt because the people in this ER depended on it. Seattle Grace was one of the richest and best hospitals in the country -  and for so many of the residents and attendings, the only reason they were there was to perform surgery. If they saved lives, that was almost incidental.

Let me share a particular storyline from the sixth season of ER. We’ve been introduced earlier that season to ‘Doctor Dave’ Malucci (Erik Palladino). In just the space of two episode he’s already become one of the most unlikable characters on the show, always interested more in exciting traumas than patient care. He will only get worse as the season progresses, constantly bellyaching about the lame procedures, trading ‘dull’ cases for exciting ones, and eventually revealing his incompetence. By the end of the season he is told in no uncertain terms he doesn’t have what it takes.

We get the first real sense of that in ‘Sins of the Father’. A teenager has come in with an attempting hanging. “Looks like a bad case of rope burn,” Dave says cheerfully, a term so tone-deaf the paramedic stops her briefing to say: “Excuse me?” Malucci badgers Greene to let him insert a G-tube, a procedure he hasn’t done yet.

While this is going on Dr. Gabriel Lawrence (Alan Alda in a role that would earn him an Emmy nomination) comforts the girlfriend and goes to check on the trauma. He asks how things are going and Dr.  Dave cheerfully says “Great’ because of how well his procedure went. Lawrence turns to Greene and asks for an update. Mark says the prognosis is hard to tell and Malucci again dismissed it because of the oxygen deprivation. “We’re probably look at veggie-burger here.”  At that moment the girlfriend has entered and hears this. She runs off in tears.

Lawrence has been relatively mild in his disposition. He turns to Malucci:

Lawrence: “You’re a resident right.” Before Dave can finish his yes:

“Well, one thing you still have to learn is that every patient is somebody’s boyfriend. Girlfriend. Brother. Sister. Mother. Father. They don’t exist simply for you to learn new and more interesting procedures.”

Dave weakly says he didn’t see her.

Lawrence: Yeah, well maybe next time open your eyes before you open your mouth.”

Now Greene has little patience for Lawrence, who was hired without his consent. He’s also generally mild with his criticism compared to everyone else.

Malucci: What’s with the new guy, right?”

With scorn we almost never hear from the mild-mannered attending:

Greene: “Which new guy would that be? Dr. Lawrence or you?”

He snaps off his gloves and walks out.

It’s worth noting that for the two seasons he is on the series Dave never truly picks up either the nuances or tones of being a doctor and when he is finally fired at the start of Season 8, though the circumstances are dicey few could argue he’d be missed.  The hospital had given him every opportunity to improve and every chance he dropped the ball.

Now consider some of the things that the five interns who start Grey’s Anatomy do in their first year of residency (which encapsulates the first three seasons). Both Meredith and Christina sleep with their attendings and begin affairs with them, despite the fact that is against the rules. It’s eventually cleared by the hospital but only after it becomes obvious for both. Both residents use their attendings as a push for favoritism throughout the first year and after some pushback, no one objects that much from the chief of staff.

When Preston Burke is shot and suffers tremors, rather than tell the Chief Christina assigns herself all of his surgeries and performs them rather than him. She keeps it a secret out of fear of Burke’s career but doesn’t seem to mind that she’s performing surgeries that the attendings should be, which might be considered a liability issue for the hospital. (She also shows no guilt about it; in a later season she actually says her illegal work should be a reason she’s allowed more responsibility in this hospital.)

Alex Karev has multiple affairs with almost every female on the staff, and at one point begins an emotional affair with a trauma victim from a crash who has amnesia and needs facial reconstruction surgery. While Denny’s emotional affair with Izzie was going on, he was dating her and knew how wrong it was but sees no problem with it – even when he later learns his patient is married.

All of the attendings, as I mentioned in the first article, are guilty of some form of conspiracy involving Denny Duquette’s case that eventually leads to his death. None of them display much in the way of bedside manner (they periodically have lunch in the coma ward) and almost none have any real connection with their patients or feel they even have to talk to them. All of them view them as ‘new and interesting procedures’ – at best.

None of them receive so much as a reprimand during this period or it should be mentioned well past their third year of residency, even though all of them have engaged in behavior that is at best incompetent and as worst malpractice. I’d say the residents get away with murder were that not copyrighted by a different Shondaland show. It’s one thing that they’re bad people  - that’s basically de facto what all Shondaland characters are – but they’re not even good doctors.

Now to be fair, throughout ER’s run we see over and over that the surgical residents and surgeons  have the same arrogance to the point of obliviousness. The most hated character on the series Dr. Romano famously isolated everyone during his rise to the top and showed no compassion even when he was injured. His identity was wrapped in being a surgeon and he seemed fine showing a lack of compassion to everyone – including the people who might offer sympathy to him.

But Romano serves as a contrast to most of the surgeons we meet at ER who do have a better work-life balance. Famously when Eriq LaSalle left the show in Season 8, the arc that led to Benton leaving the show involved his having to take custody of his son Reese who he’d fathered out of wedlock back in Season 4. When his mother dies in a car wreck Benton soon becomes involved in a custody fight with Reese’s husband Roger (played by Vondie Curtis-Hall in the arc). In the custody dispute, it becomes clear that Reese is not Peter’s biological son and that for most of Reese’s life, Peter has shafted custody duties on Carla and the rest of his family to pursue his career. As Roger points out “Reese has spent more time in our house than Peter’s.”

In order to accommodate this Peter gives up his full-time residency for a less-demanding job at the hospital where his girlfriend Cleo Finch (Michael Michele) now works. Romano refuses to accommodate his demands and when Peter resigns, he is enraged: “You’re going to quit to play Mr. Mom?” he shouts as Peter leaves his office. But it is clearly a big decision for a man who spent his entire life built on his surgical career. It’s telling that Meredith Grey never considers a similar option even after giving birth  - and refuses to consider moving to DC when Derek gets a job offer there.

And its worth noting that Dr. Morgenstern, after suffering a heart attack in the Season 4 premiere, after coming back in the middle of the season, eventually chooses to resign because “I just don’t feel like I belong here.”  When the series begins Weber is contemplating named a successor for which Derek and Burke are the prime contenders. No matter how much his marriage is on the verge of first failing, or when his wife first develops Alzheimer’s and then dies has Richard ever contemplating leaving Seattle Grace for good and he seems no closer to doing so after twenty seasons.

In what would be their last exchange as Mark Greene leaves the ER for the last time, Kerri Weaver turns to him and asks: “How many shifts should I sign you up for next month?” She knows Mark is dying of cancer but she cares for him so much that she thinks by letting him keep working is a sign of their trust and bond. Mark, who has just decided to die on his own terms, turns to the woman who has been rival and frenemy for seven seasons. “Never let your work become your life,” he says sincerely. “Live a little, Kerri.”

No one in 20 seasons of Grey’s Anatomy has seemed capable of understanding the simple truth of that statement. For one of the longest running shows on TV work is life. In the real world, where so many people are coming to question whether they spend too much time at work as a rule, this message seems remarkably tone-deaf. On a show where all of the doctor’s personal life, happiness, marriages and friendships have been sacrificed in the name of this job,  it seems insane.

Now I do realize that this argument would seem to booster my claim that Grey’s Anatomy is just a soap opera set in a hospital. But the message that work is supposed to provide you with more fulfillment then your personal happiness is a very toxic message for a TV show to provide. And what makes it all the more galling is that over and over on ER we saw far better that love stories could happen at work – and you could have it all.

In the next part of this series, I’ll explain why ER showed romantic love far better than the supposed greatest love story of this century – Derek and McDreamy – ever did on multiple occasions.

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