What the heart wants

NBC’s Heartbeat featured expert physicians, with a nurse as skilled handmaiden

The 2016 NBC show Heartbeat focused on a female cardiac surgeon and other physicians. It did have a recurring nurse character, but she never got beyond skilled aide-de-camp status. And it was finally revealed that she wanted to be a physician, reinforcing that nursing stereotype.

May 2016 – For its one season, NBC’s drama Heartbeat focused on hotshot cardiac surgeon Alex Panettiere, who was based on real-life surgeon Kathy Magliato. Alex swaggered and charmed, broke rules and pioneered treatments, juggled lovers and fought the power in a man’s world. All of the show’s important characters were physicians, but there was a regular nurse character, Ji-Sung Myrong. She was a respected and skilled aide-de-camp, a type of nurse character seen on other recent NBC shows like Chicago Med and The Night Shift. Ji-Sung seemed to be charged with keeping Alex on track logistically. She also performed some basic care tasks and occasionally discussed patient care with the physicians, displaying a certain sour wit in bantering with them. Ji-Sung’s snarky remarks placed her well clear of the angel stereotype, not bad in a show with the word “heart” in its title. She even talked to patients! Unfortunately, those good elements were undermined by the ninth episode, in which it was revealed that Ji-Sung had previously started medical school in Korea and was eager to get back to it. That reinforced the wannabe-physician stereotype seen in so many other shows’ portrayals of able nurses. And it meant that viewers would likely credit medicine for Ji-Sung’s clinical merits. Another episode featured cutting-edge care robots rolling around the hospital. The show did not explicitly call the robots “nurses,” but Ji-Sung’s physician suitor did name one “Florence Nightingale;” Alex’s favorite robot was “Channing Tatum.” Ji-Sung herself said she did not mind the robots as long as they did not put her out of a job. (Could they? No.) So in light of those plotlines, the overall focus on physicians, and the mute-assistant mode of the other nurse characters, the show was not very helpful. Heartbeat stopped after a 10-episode first season. The creator was Jill Gordon.

Love poems

Florence Nightingale

“I never stopped wanting to be a doctor”

 

Love poems

Overall, Heartbeat fit the standard physician-centric model for Hollywood shows. All but one of the nurses who appeared were meek servants who seemed to be there to accept commands and hold things. Physicians provided all important hospital care, including the psychosocial aspects.
 
However, in some scenes, Ji-Sung was a relatively strong, calm, and skilled nurse character. It’s true that the show devoted less screen time to her clinical care than to the surgeon Callahan’s romantic pursuit of her, efforts that she spent much of the season dismissing, although she gradually relented. In a March 2016 episode, she virtually ignored one such approach in the hospital cafeteria, continuing to read her copy of Pablo Neruda’s Love Poems.

In her limited clinical interactions, Ji-Sung did project competence and even some irreverence, although there was little question that her main role was to serve Alex. After one adverse surgical event in episode 3, Alex was polite in giving commands, prompting Ji-Sung to note that it must be a serious situation since Alex was using words like “please and thank you.” Ji-Sung asserted herself even more with Callahan. In that same episode, Callahan was preparing to take a blood donation from Ji-Sung to address an urgent need. Ji-Sung objected that she could take her own blood, because “everyone knows doctors are the worst person to take your blood.” He promised to be gentle. And she was impressed with his technique, saying “nice stick.” He responded that he did have a nice stick. Ha ha. But at least the show did get in a passing suggestion that nurses might have some health knowledge and skills.

Ji-Sung and Callahan
Ji-Sung did at times display such knowledge and skills. Episode 7 was mainly about a transgender woman with breast cancer. When we first met that patient, Ji-Sung was taking her blood pressure. Ji-Sung also seemed to be part of a kind of intake meeting for the patient, along with Alex. Ji-Sung helped the patient get settled in pre-operation, bantering about her nice skin pores. And Ji-Sung played a key role, along with the physicians, in the episode’s female-oriented psychosocial care for the patient. For example, she negotiated a compromise with Alex – the patient could not wear lipstick to her operation but could wear a fabulous pair of glasses! At another point in this episode, Ji-Sung was at the table for some kind of staff meeting with the physicians, a rare example of nurse involvement in decision-making on a major network show. (Granted, the involvement of nurses in decision-making is not common enough in real life either, which is why the Nurses on Boards Coalition is an important initiative.)

Florence Nightingale

The health care robots formed a minor comic-relief subplot in episode 5. That subplot also served in part to advance the mostly comic Ji-Sung/Callahan romance subplot that ran throughout the season. In an interaction early in the episode, Ji-Sung refused to have breakfast with Callahan because, on a sort-of date they had recently had, Callahan had accidentally “grazed” her breast in trying to keep her from falling down after she tripped. Callahan was exasperated at Ji-Sung’s unwillingness to understand and get over this.

In a later scene, Alex appeared in a hallway with some apparent resident physicians, showing them one of the mobile medical robots she was bringing to the hospital and explaining how they would “revolutionize patient care.” Plus, they were “incredibly cool.”

Alex: They use digital maps to navigate and ultrasonic sensors to move freely throughout the hallways without colliding into humans. [After she got in the robot’s way and it said excuse me, Alex addressed it.] Oh, no problem, Channing Tatum. … Everyone deserves a name. … He’s polite, dependable, hard-bodied. What else would I call him? He can also dispense drugs, meals, clean linens…

But wait! That was not the cutest robot name the show had to offer. Callahan soon approached with another robot—which had a blue and white nurse’s cap—and completed Alex’s sentence about what the robots can dispense.

Callahan: And lattes. [His robot gave him one.] It’s a skinny latte. Florence Nightingale, you’re the best.

Florence: [British accent.] Thank you, Dr. Callahan. Looks like you’ve been working out.

Callahan: [Reacting to funny looks from the other physicians.] What? They all have speech modules built in, so I figured I’d give ‘em a few new things to say.

Ji-Sung: [Arriving.] As long as these buckets of bolts don’t put me out of a job, I’m happy to let them do grunt work. [To Florence.] Open. [A compartment opened and Ji-Sung placed a tray with little cups of pills inside; Florence accepted them.]

Florence: Girl, you so fine it’s criminal.

Ji-Sung looked intently at Callahan, knowing he was responsible for this last comment.

Later, Channing Tatum bantered with Alex as she tried to master a remote surgical tool. After her efforts went poorly, the robot observed, “You look like you could use a hot oil massage.”

At one point, Callahan tried to use Florence to deliver gifts to Ji-Sung in a further attempt to make up for the grazing incident, even including a note saying that Ji-Sung could “kick me in the balls to make us even.”

But an ally of Ji-Sung’s, a scary anesthesiologist named Forester, intercepted this package in an effort to shield her from Callahan. Callahan tried to raise the robot delivery attempt with Ji-Sung as they interacted with the robots. But she shut him down:

“Don’t touch my stuff [the robots]. My stuff or my boobs, both are off limits.”

Later, Callahan returned to the subject of his gifts, referencing chocolate and roses. But of course Ji-Sung never received those, so she did not understand. Callahan started ranting that he thought Ji-Sung was different, but it turns out she’s stuck up and emotionally withholding,

“like a lot of beautiful and smart and sexual and…you have no idea what I’m talking about.”

Ji-Sung: “No, crazy man.” She walked away.

Callahan finally understood that she never got the gifts.

Callahan flagged down the robot: “Flo, wait up.”

Florence: “I’m on break.”

Ha ha, because “I’m on a break” is what nurses are all about, especially Nightingale.
 
Comparing health care robots to nurses is generally unhelpful because it reinforces the idea that nurses do only straightforward physical care tasks. In reality, nurses are college-educated science professionals who use critical thinking and advocacy to save lives, as Nightingale herself did. Here, Ji-Sung did refer to the robots dismissively as her “stuff” and as “buckets of bolts” who did “grunt work.” So there was a sense that they were basic and that she owned / ran them, rather than that they were peers. But Callahan did call one robot “Florence Nightingale,” even though that may have reflected his interest in Ji-Sung more than any active belief that the robots were functioning as nurses. Florence flirted with both Callahan and Ji-Sung, and Channing Tatum did so with Alex, an echo of the naughty nurse stereotype. And Channing was named for an actor noted for a role as a sex object. No robot was named for a physician. Perhaps the nursing comparison seemed plausible in terms of the robots’ limited and mildly sexualized work roles. Ji-Sung addressed the work roles directly with her remark about the robots not putting her out of a job. Were we supposed to wonder whether maybe they actually would? After all, we did not see Ji-Sung do much that required a lot of clinical judgment, nothing like Alex. And aside from the zany comments that Callahan programmed Florence to say, the robots appeared to be as the characters described them—dependable machines doing fairly simple tasks. Of course, Callahan did call Ji-Sung “smart.” But that was a throwaway line that can’t compare to the impression left by physician characters actually being smart in using their clinical skills to save patients, something we did not see from Ji-Sung or any other nurse character. Unsupported praise doesn’t mean much next to what people actually experience. As Carl W. Buehner observed, “they may forget what you said — but they will never forget how you made them feel.” On balance, the nursing comparison was unhelpful, if not insulting.

“I never stopped wanting to be a doctor”

The ninth episode revealed that Ji-Sung was in fact an aspiring physician. The episode seemed to start pretty well. Ji-Sung sat in on a meeting with Alex’s team of physicians. They discussed cases and Alex gave assignments! Ji-Sung got to conduct research in a database for relevant studies on the heart defect issues they were facing. That was quite a substantive task for a nurse to be doing on a Hollywood show, even if it was only at the command of a physician.

Ji-Sung and Callahan were later seen arranging a meeting in the hospital’s cadaver room. Viewers were meant to imagine a hookup, but it turned out to be so they could open up a body Callahan had obtained, and Ji-Sung could dig around in the body and identify internal organs.

Callahan: Now, can you name all the blood vessels off the abdominal aorta?

Ji-Sung: Phrenic, splenic, superior mesenteric, inferior mesenteric… Oh, I can’t remember. Oh my God! This is one year of medical school in Seoul down the drain if I can’t pass this exam. I’m never gonna be a doctor.

Callahan: Why didn’t you finish over there?

Ji-Sung: Because … My cousin got sick in the States. I left med school in Korea to come back here and take care of her. And thought I’d find a way to continue. But med school is very expensive. Nursing school is cheaper and faster. But I never stopped wanting to be a doctor.

Callahan: Good. Can you tell me what’s wrong with this guy’s liver?

Ji-Sung: It’s a female.

Later in the episode, Ji-Sung was seen working on what appeared to be a chicken. She told Callahan that she needed to practice separating the fascia. He was impressed and offered the advice that if she relaxed her wrist it would reduce fatigue. She returned the favor by letting him know that his fly was down. It was not, but he thanked her for checking him out. “Gross,” she said. Callahan persisted, saying he wanted to get to know her, have a personal relationship. She said sure, as long as there was dead flesh between them. Callahan said he could work with that.

Some of this would be all right if Ji-Sung was considered a nurse. She showed health knowledge and bantered with a physician as an apparent peer; there was nothing of the naughty nurse in those interactions. But the plotline reinforced the incorrect stereotypes that able nurses are wannabe physicians and that nursing is a lesser option for those who can’t do medical school for whatever reason. In fact, while nursing school can be “faster and cheaper,” nurses do need to know anatomy, and nurses save lives. Nursing is no less valuable than medicine. And nurses are far more likely to pursue graduate education in nursing than medicine. Because of this medical student element, everything that the Ji-Sung character had already done and would do on the show might not be credited to nursing, but to her status as a would-be physician. Did Ji-Sung only get respect from the physician characters on the show because she had that status? (It has worked that way on other Hollywood shows; when a nurse character announces medical school plans, respect immediately follows.) No other nurse characters got any attention on Heartbeat. In one minor plus, the show at least resisted the false suggestion that Ji-Sung, as a medical student, could automatically become a nurse without attending nursing school.

Nothing happened to change this dynamic in what little remained of the show. In the series finale, we saw Ji-Sung in the OR, displaying expertise and getting positive feedback from Callahan. But of course, at that point attentive viewers could tell that it was at least as much as about her potential as a physician; Callahan seemed to be guiding her toward his own specialty of surgery. And perhaps that potential was also what made her worthy of Callahan, to whom she finally gave in toward the end, bestowing a kiss after he charmed her with a candid story about how he had become alienated from his heartless peers at Harvard Medical School, long ago.

Heartbeat might never have been good for nursing, given the limits of Ji-Sung’s clinical care. But it could have been fair in the sense of presenting a nurse as a sentient, trusted, and even irreverent health team member, even if that team was predictably dominated by physicians. And perhaps the show did have that effect for viewers who did not see the wannabe physician plotline toward the end of the series. But overall, it was another in a long line of missed opportunities for Hollywood to show viewers something of what nursing really is.

If you would like to send feedback to Heartbeat‘s creator, Jill Gordon, you can reach her through her Creative Artists representative Kathy White at kwhite@caa.com. Please also blind copy us at letters@truthaboutnursing.org so we can hear your thoughts. Thank you!

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