ACA

I bunched these works under the name “ACA.”

As in Obamacare?

Yes. The Affordable Care Act. But more than half of these works are set before that act became law.

Let me guess: Not much has changed.

Correct. There are 50 years between Frederick Wiseman’s “Hospital” and the docuseries “Lenox Hill.” The hospital as an institution has not evolved in half a century. What I like about “Lenox Hill” is that they discuss the business of running a hospital. Talent attracts surgeons who will do procedures that will generate income for the hospital system. Caring in a capitalist society is a business, whether you’re a safety net hospital such as Metropolitan Hospital or a fancy community hospital such as Lenox Hill. So Richard Widmark’s Chief of Surgery character in “Coma” can feel justified in his shady scheme.

(d. Frederick Wiseman, 1970)

(2020)

Do you think Paddy Chayefsky saw Frederick Wiseman’s “Hospital” and then wrote “The Hospital”?

They’re set in the same hospital. Most likely yes. As much as I love Chayefsky (a fellow DeWitt Clinton High School graduate), “The Hospital” has not aged well.

Because of the hospital murders?

A message with a blunt scalpel: Hospitals kill because they don’t care. I enjoyed that. Also got a kick out of seeing Frances Sternhagen asking for insurance information from a patient in the emergency room. And Stockard Channing as an ER nurse. The main reason it hasn’t aged well is Diana Rigg’s character, Barbara. She’s an ex-nurse, a counterculture foil to George C. Scott’s Chief of Staff MD. She works out her daddy issues / institutional issues with him overnight.

(d. Arthur Hiller, 1971)

Not a good portrayal of nursing in the media.

Nor is Elizabeth Ashley’s nurse in “Coma.”

Well, she’s scary in person.

The nurses in “The Student Nurses” are more exemplary.

Isn’t that a soft core flick?

Yes. But they were drawn better than Chayefsky’s nurses. My nursing professor would’ve probably failed me if I admitted to liking “The Student Nurses.”

(d. Stephanie Rothman, 1970)

Tell me a moment when you were a student nurse. Did you fantasize about marrying a doctor?

No. “Grey’s Anatomy” had just premiered and our nursing professors demystified a lot of their storylines in class. As soon as we did clinicals, that demystified a lot of Hollywood Hospital. Believe it or not “The Student Nurses” really did remind me of being a student nurse. 

Where were their preceptors?

I know, they had no preceptors! They were student-nursing on their own! Independent learning. They were assigned to different clinical areas, the way we as student nurses were. But it shows you that nursing’s purview is wide. I think the movie is so insightful about that. The student assigned to community nursing  became part of a social justice endeavor. Nursing can go beyond the hospital.

That nurse falls for a radical in a poor community.

It’s a skin flick with a lot on its mind. Maybe because it was a skin flick that its director Stephanie Rothman managed to get away with a lot. Like talking about abortion honestly.

Could you imagine paying to go see this movie to get titillated and then bump into an abortion subplot?

You got a lot of sex before getting to that plot point. It showed you what an elective abortion was during that time.

If you knew a doctor who could come to your house ...

True. Abortion runs through this group of works. “Coma” has a therapeutic abortion in its plot. When the patient ends up in a coma, how you feel about her depends on whether you’re pro-choice or pro-life.

(d. Michael Crichton, 1978)

If one were pro-life, one would think she deserved to be hung in wires, like the comatose patients in the movie?

I must say that was a lot of OR manpower for a therapeutic abortion. 

It’s not that intense anymore. “Never, Rarely, Sometimes, Always” walks you through the 3-day process. 2 days if you had an early appointment.

(d. Eliza Hittman, 2020)

I thought that would be a nail-biter like “4 Months, 3 weeks and 2 days,” but it’s not. And then I realized we are not 80s Romania yet. Abortion is still legal in this country, but access has become difficult. There’s no shady doctor in “Never, Rarely, Sometimes, Always.” The obstacles are also not easy. 

The movie talks about the abortion procedure in a factual and non-judgmental way.

The most painful part of that movie was the questionnaire. Not the procedure.

A good questionnaire can mine the truth.

That scene is pure acting. Reminds me of some Acting I exercise when we were given the most ordinary words and act it as a scene.

If there’s a main theme that courses through these works it’s that of access. That’s what Obamacare was supposed to do, right?

Access to abortion in “The Student Nurses,” “Coma,” and “Never, Rarely, Sometimes, Always.”

Also access to care.

Metropolitan Hospital is still around, thank God. There are two moments in Wiseman’s “Hospital” that stand out. The doctor calls New York Hospital (now New York Presbyterian - Cornell) and complains about sending a patient from there to Metropolitan’s ER. The implication is that the patient was probably not a desirable patient financially for them. The other moment is when a psychiatrist phones for help to prevent a gay hustler from ending up in an institution.

Access to the top, in the case of “The Beauty in Breaking: A Memoir.”

The author of that book, Michel Harper, writes about being passed for a promotion because she’s black and a woman. Her experiences as an emergency medicine MD are similar to the scenes in the emergency room in “Lenox Hill.”

(2020)

Tell me a moment when you were breaking.

Breaking as in crying? Like that neurologist in “Lenox Hill”? A night when my patient died surrounded by his family and I cried with them. I cried some more in the staff bathroom. Then I received my new admission later that night. He was a patient I had taken care of before and lost his vision because of his worsening disease. He didn’t see me cry because he was blind. But I went to the bathroom again and cried some more.

What was the beauty in that?

Michele Harper likens it to kintsugi after you piece yourself back together. You don't have access inside me - You can’t see it, but I’m mended with gold, silver, and platinum inside.

Pall Care

Palliative care may have been a new terrain for me as a student nurse, but it was a place I felt comfortable navigating. Hence, I gravitated towards oncology. My interest in works about death and dying is a busman's holiday. It's a peek at the other side, the patient's side.

In the three works below, terminal illness is characterized as new terrain. With the diagnosis appears new shades that contour the characters' physical worlds. Light is perceived anew, so is breath, and so are priorities. In terms of diagnoses: Nina Riggs writes about her breast cancer journey, Molly Shannon's Joanne has leiomyosarcoma, and the patients in "Extremis" represent the typical medical ICU population.

I appreciate "The Bright Hour" and "Other People" most for their honest humor. They appealed to my morbid sense of humor. Part of what draws me to these works is that it is a terrain (barring a swift death) that I will likely enter. Protracted illness is a product of modern medicine. The works provide an aerial view of the terrain, not street directions. In all three, what one can clearly see is that autonomy in how one chooses to die is a value to be upheld. 

The Bright Hour (2017)

by Nina Riggs

Memoir: terminal

Diagnosis seen as new

Terrain and new light.

Other People

(2016, dir. Chris Kelly)

Year with dying mom.

Home turns to new terrain for

Caregivers, patient.

Extremis

(2016, dir. Dan Krauss)

Too brief exam on

Palliative challenges in

Modern medicine

KS, Baby

Walked into a scene right of "Angels in America" last night.
This play is so embedded in me that it will never leave me.
30 years in the AIDS epidemic, I saw my first Kaposi's sarcoma last night, uncommon in the age of antiretrovirals - and the scene below flickered in my mind.



In eliciting the "history of present illness," I saw that the patient and his partner were more like Prior and Louis. I was spared the crying, but not the drama of it all.

Dropsy

Finally getting around to "Downton Abbey", a Masterpiece Classic update of "Upstairs / Downstairs" on PBS last year.
Loving it more now that they introduced a nurse as one of the main characters - an undesirable addition to the titled family because of her profession. She saves a man's life by advocating for pericardiocentesis and a dose of adrenaline on a patient with dropsy.

Dropsy?!

"Dropsy to the heart or the liver?" she asks.

What in Flo's sake is dropsy?
A colloquial British term I've never heard of?
Google to the rescue; dropsy means edema.
So, what other archaic terms for medical conditions that have gone the way of smallpox.
Le grippe, consumption, ague, coryza, Saint Vitus's dance, suppuration ...
Not to mention the more recent ones. We don't call it left-sided or right-sided heart failure anymore. It's now either systolic or diastolic dysfunction.

Since gerontology will be my specialty, someone old enough is bound to use them. I can only imagine:

"What can I do for you today, Mr. Smith?"
"My podagra's acting up again."

BMTs

Personally, I find allogeneic BMTs frightening for its upsetting side effects. GVHD has horrendous clinical manifestations. But I have to let that go because it is what the patients want. T. Brown, RN on the NY Times' Well blog felt the same distress, but who are we to take that hope away? Below is a feel-good piece that re-affirms why I do what I do. I applaud those who are on the registry. I know of one who's on the registry who worries they might call him one day. Take heart, "walking funny for a week" and some pain seem to be the only unpleasant complaints for a donor post-collection.

The Gift of a Lifetime
How a Woman Who Died in April 1999 and an Infant Diagnosed With Leukemia Became Connected by an Act of Kindness
from "CBS Sunday Morning"

PE, cont'd

Wouldn't you know it? My teacher brought up the Stanford 25 (previous post) in class because Dr. Verghese was profiled in in the NY Times. I was ahead of the curve.

Physician Revives a Dying Art: The Physical
By DENISE GRADY
Published: October 11, 2010
At Stanford, Dr. Abraham Verghese is on a mission to bring back something he considers a lost art: the physical exam.

I volunteered that I had read this two weeks ago and brought up the limitations chimed in by other MDs in BMJ. She seemed put off by that. I agreed with her though that RNs beat PA's and MD's when it comes to "touch"-ing a patient. Because we're a touchy profession.

PE

On "The Fading Art of the Physical Exam," by Richard Knox from NPR.org

I'm not for going back to the days of Dr. Quinn, Medicine Woman or even Dr. Kildare.

Since I will be a “mini-doc,” as my Advanced Health Assessment prof put it, the Stanford 25 seems like a standard to look up to as a program objective. (There are limitations/criticisms.) Nurses are trained to do a physical exam (PE). Yes, we learned these PE skills in nursing school, but do not keep it up. Depends on where we practice. In a hospital setting, MDs and diagnotic machines are within easy reach, so nurses' PE skills rust. Upon review, not many of my nursing preceptors emphasized PE skills in practice when I was a student. Many of my colleagues do not carry a stethoscope around, so I can bet they don’t listen to breath sounds or bowel sounds and are only forced to use it when they have to take a BP manually.

A & P

Remember in Anatomy and Physiology Lab when the TA's told us to treat the human skeletons with respect? Probably because of these cut-ups from med schools way back when. Their sense of humor was as morbid as ours.

The tableaus reminded me of a school project college students submitted at the nursing school my mother taught in the Philippines. The students had to present dioramas of frog skeletons as their final project. The dioramas I saw included frogs dressed as the Beatles in a concert, frogs in a fashion show, and frogs riding a car. Don't know for which class. Biology, maybe? Luckily, we didn't have to do that here. The dissecting part and the dressing up part, I wouldn't have a problem with. But hunting for frogs? Imagine trying to catch them in your backyard?

"A Student's Dream"

From NPR: Portraits Capture Life In Dissecting Class