Thursday, August 03, 2006

Today's Burning Question

Where are the chaplains in TV medical shows?

Gary and I are big "ER" and "Scrubs" fans (although we're always a little behind, because while we have a big TV, we actually only use it as a giant DVD player for Netflix rentals). A few nights ago, we watched an ER episode where Carter goes into the hospital chapel to try to convince the grieving mother of a braindead son to donate his organs, since a sixteen-year old girl with his exact rare blood type, who needs a liver transplant, has just shown up in the ER. Oh, and it's Christmas Eve. (Talk about rickety contrivances of doing good!) And Carter and Lucy spend a lot of the episode talking about whether they believe in God or not. And I think the hospital in the show is supposed to be a level one trauma center, which would be mandated to have a chaplain on call 24/7.

And there's not a chaplain in sight. That episode was the first we'd even seen of the hospital chapel, which is filled with fresh flowers and must therefore be populated and maintained by somebody other than this one mother. Later we see a priest giving the son last rites, but my impression was that he'd come in from outside, and might in fact have been the same priest who'd been brought in by another distraught mother to try to convince her thirteen-year-old daughter not to have an abortion. Maybe he also stocks the chapel with flowers in his spare time. This is season five of the show, and the chapel has just popped up out of nowhere.

The absence of chaplains is even more glaring on "Scrubs," which is set in Sacred Heart Hospital, for crying out loud. They'd have a pastoral care department. They'd have staff chaplains. They might even have volunteers. No way would Turk and Carla, after Turk stands her up at the altar because he has to perform emergency surgery, then wind up being married by the surgery patient, who just happens to turn out to be a priest, as Turk and Carla conveniently discover after they've gone to the hospital in their wedding finery to check on how the guy's doing.

Right.

M*A*S*H* had a chaplain, and in my foggy memory of the show, he even got his own story arcs and plot crises sometimes. "Firefly" had the very memorable Shepherd Book. (Simon's also one of the more believable doctors on TV; but then, Joss Whedon is the God of All Storytellers, so we shouldn't be surprised.) Where are the chaplains in the current shows?

Okay, there are plenty of other unbelievable things about TV medical shows. Gary and I gave up on "Grey's Anatomy" after the second or third episode, when a Concerned Surgeon sits by the bedside of a comatose patient for something like ten hours so he'll be there when she wakes up. Oh, sure. Surgeons do that all the time, because they have such relaxed schedules. And then there are the "outside the hospital" episodes on "ER": you know, like when Carol leaves the hospital during her shift to try to track down the estranged wife of a dying patient so she can come say goodbye to him, or the ridiculous episode where John and Lucy run all over Chicago, scaling fences and racing through traffic, to try to track down the missing father of a dying child with another rare blood type -- rare blood types are a staple of these shows -- because Only His Blood Can Save Her. (The realism of that episode was redeemed somewhat when the kid wound up in really grim shape anyway.)

"Outside the hospital" episodes remind me why I stopped reading the Cherry Ames books when I was a kid. I'd devoured all the Nancy Drew books, and I was looking forward to reading about a nurse instead of a detective, but Cherry kept turning into a detective about twenty pages into each book. It really drove me nuts. If you want to be a detective, go to the police academy! I thought I was going to be reading about a nurse! This is major dishonesty in advertising!

The best candidates for tracking down missing family members would be social workers. They rarely show up on medical shows either, although they're vitally important in hospitals.

Oh, and then there's the issue of codes. I've seen hospital workers elsewhere in the blogosphere grumbling about the TV fallacy of the code patient who arrives on an ambulance gurney with somebody perched on top of it, doing CPR. My own pet peeve is the Fallacy of the Uncrowded Code: our favorite doctor or medical student is alone in a room with a patient, with maybe just a nurse there too, and the patient codes, and the lone doctor and nurse attempt to resuscitate.

Nope. Codes get called out on the overhead, whereupon at least one doctor, a horde of nurses, a couple of respiratory therapists, and -- apparently -- just about anybody in the hospital with nothing else to do crams into the room (and yeah, there will probably be pastoral-care types hanging around too, especially if the patient's family or friends are there, although all of those folks are usually outside, because the room itself is too crowded). And that's just the people: never mind all the extra equipment.

And, mind you, I really know very little about all this. So if I'm picking up on these mistakes, how many more must there be?

Somebody needs to do a hospital show about the people who never get airtime on other hospital shows. Chaplains. Social workers. Security guards. Dieticians. Admitting clerks. Physical therapists. There are plenty of stories there, and you wouldn't even need to make them unbelievable to make them interesting.

4 comments:

  1. Well, did you find your way to the Sue Barton nurse books?

    Good point, though, about how much hospital staff is non-MD. I was in the hospital for a couple of days after Nathan was born and probably spent about 15 minutes in the same room with doctors, and that includes the pediatrician (but not my roommates' doctors).

    But what about all this press lately about the huge volume of stupid medication mistakes in hospitals that kills thousands of people every year? I believe this is related to something I've observed that really tries my patience--a lot of medical service people (in hospitals and in doctors' offices too), while often (but not always) extremely kind and thoughtful, just live in another world where the standards of accuracy, efficiency, and prompt, courteous service that pertain in the corporate world simply don't exist. Since I know you dislike and avoid the corporate world, you may not have noticed and may not even care, but since I've been expected to meet those standards on a daily basis for years, it can really drive me nuts.

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  2. No, I never read Sue Barton; never even heard of her until today!

    Too many hospitals are chronically understaffed, which probably accounts both for many mistakes and for service delays. I suspect that there are huge volumes of mistakes in every other area of human life, too: they just don't kill people as often.

    I do know what you mean about the difference between healthcare settings and the rest of the corporate world -- other friends of mine complain about this too -- but on the other hand, a LOT of patients have very unrealistic expectations about how quickly they should be seen in, say, the ER (where I volunteer), despite the signs hanging all over the waiting room explaining the triage system. It's not first-come, first-served: it's sickest first.

    Sometimes patients in the waiting room will ask if I can estimate how long it will take them to be seen, and I always say, "No, I can't, because any estimate I gave you could change in the next five minutes if three ambulances come in." I always tell people that I know it's frustrating to have to wait, and that I'm sorry; I usually also give them some version of my "You never want to be the center of attention in an ER" speech.

    I've been the person with a badly sprained ankle who had to spend five hours in the waiting room; I've also been the person with a life-threatening infection who was the center of attention and wound up being admitted to the hospital for four days after only an hour in the ER (you remember that, Claire!). The first position is by far the more desirable. My own algorithm for dealing with this stuff is that the longer you have to wait in the ER, the less total time you'll spend in the hospital, because the more quickly you get seen, the higher your chances of being admitted.

    Ambulance patients are usually seen more quickly than walk-ins (or at least get back to the actual ER more quickly, since they bypass the waiting room). Chest pain, especially with shortness of breath, takes priority over almost everything else.

    Re hospitals versus corporate: most people in corporate settings don't work twelve-hour shifts where they're on their feet most of the time and have to make life-or-death decisions, often on behalf of people who are verbally abusive or in restraints or otherwise difficult and unpleasant to deal with. Twelve-hour shifts actually reduce error, because most mistakes occur around shift changes, but those folks are tired by the end of their workday, and yes, sometimes courtesy starts fraying at the edges. Overall, I think it's amazing that there aren't more errors.

    Of course, a lot of what I've said doesn't apply to medical or surgical floors, but I haven't spent enough time in those places to feel qualified to talk about them.

    By the way, my mother informs me that the "real" hospital shows she watches -- which Gary and I don't watch, at least not yet -- do have chaplains. Yay!

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  3. Hi Susan,

    I know this post is old, but had to add a new comment anyway! Read on:

    I almost never watch broadcast TV, much less an ER that isn't a rerun, but I did last night (9/28 already) and I'm sure you'll be gratified to know there WAS a chaplain in the episode! A mother called for the chaplain to join the OR team for emergency surgery on a teeny distressed preemie baby from the NICU (we won't say whose!) because the father had wanted to have the baby baptized and the outcome looked so iffy. My predictible plot-meter suggests there had previously been conflict between the parents over whether or not to baptize, but I missed the beginning so can't say for sure.

    Anyway, the chaplain appeared in the OR scenes, all scrubbed, gowned and masked just like everybody else except he was praying over a big black book with with a big cross on the cover conspicuously displayed in the shot. He MAY have had some kind of purple vestment on over the scrubs, can't remember for sure.

    That was it.

    Won't tell you whether or not the baby made it, I don't want to ruin the surprise for whenever you work your way through the seasons to this episode!

    Thanks again for your helpful phone advice last week. The situation has improved although not to the extent I had hoped. More details will follow, I promise.

    Take care in the meantime!

    Love,

    Claire

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  4. Hey, Claire!

    So was the big black book scrubbed, too? Jeez! Talk about taking a non-sterile object into a sterile field.

    But I am glad they included a chaplain!

    And I'm glad things are going better. Keep me posted!

    Love,
    Susan

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