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A Prescription for Realism
Just outside the high-pressure ER of fictional Seattle Grace Hospital, home of hit ABC show Grey's Anatomy, Dr. George O'Malley is about to make a stupid but believable mistake. As the doctor -- played by T. R. Knight -- sticks a needle in his patient's arm to draw blood, a drop falls unnoticed onto a piece of gauze. Instead of containing the waste, the doctor hands it, along with the blood sample, to a nurse, who passes it along to a lab tech. Suddenly, chaos erupts as everyone exposed becomes woozy and collapses.The episode being filmed comes from a real-life case in Southern California: A woman undergoing chemotherapy ingests some kind of herbal remedy, and the combination emits toxic fumes from her body, causing her attending doctors to pass out. But it wasn't enough for the producers of Grey's Anatomy to have their latest story line based on reality; they wanted to make sure all the medical details on the set added up. To do that, they called in Linda Klein, who, after working for more than ten years as a surgical tech and nurse, recently became a producer and medical consultant for Grey's Anatomy and Nip/Tuck, the popular FX series about two racy Miami cosmetic surgeons.
To show the actors how to realistically perform their doctorly duties, to make sure the props -- from blood syringes to suture-removal kits -- are authentic, and to keep scriptwriters' scenarios from veering into fantasy, Klein puts in long hours on Anatomy's set whenever medical procedures are being filmed.
"Linda takes the time to show us exactly how something should be done," says Ellen Pompeo, who plays Anatomy's title character, Dr. Meredith Grey (and, as fans will know, the love interest of Dr. Derek "McDreamy" Shepherd). "She makes sure everything is done perfectly."
As medical dramas have evolved from fiction to near fact, professionals like Klein have become the backbone of such hit shows as House and ER. They teach actors how to hold a scalpel, insert (fake) intubation tubes, perform CPR, choreograph operations, make incisions into lifelike (prosthetic) chests and brains, and speak and think like doctors -- all with the goal of giving TV viewers the prescription they've come to crave: a heavy dose of realism.
For decades, Americans have had a love affair with medical dramas, popularized in the early 1960s with the hit TV shows Dr. Kildare and Ben Casey. Back then, the parameters of medical depiction were limited. The central characters were handsome, flawless, godlike figures who rarely got blood on their hands and never made mistakes. The sanitized image of medicine and its practitioners was a reflection of the script-approval process: Until the mid-1970s, producers routinely submitted scripts to the American Medical Association for review.
By the early '70s, Marcus Welby, M.D. and Medical Center began dealing with controversial social issues -- rape, homosexuality, sexually transmitted diseases -- yet still clung to an idealized view of doctors and hospitals. In response to the profound social and political changes sparked by the Vietnam era came M*A*S*H, about an Army corps of wisecracking doctors during the Korean War. Against a backdrop of dramatic emergency surgeries performed in wartime, the medics were portrayed as heroes with flaws: libidinous, nurse-chasing boozers with hearts of gold.
"The only way the show could get away with those characters is that as surgeons, they had to be technically beyond reproach and behave correctly as doctors," says Joseph Turow, professor of communication at the Annenberg School of Communication, University of Pennsylvania.
Ironically, it was a show written by a novelist that ultimately broke through in terms of medical reality. Created in 1994 by Michael Crichton, ER launched the career of George Clooney, who played the charming, flirtatious Dr. Doug Ross. "We wanted to show what it was really like to be a doctor in an emergency setting: their flaws and exhaustion, the crowded waiting room, the explicit surgeries, successful and botched," says Dr. Fred Einesman, ER's medical advisor. "The show became a phenomenon in the medical community at the time because it was so accurate."
Einesman would know. He worked for more than 15 years as an ER doctor at Cedars-Sinai Medical Center in Los Angeles. "In the beginning," he recalls, "we said 'That's too bloody to show,' or 'We can't use technical medical jargon.' But now, viewers expect it to be real."
"In Hollywood, what sells is sex and violence," says Professor Turow. So when ER has to get people's attention in sweeps week, it has an incredible helicopter crash or a bus accident with lots of blood. Or Grey's Anatomy has two people impaled on a pole.
Today, there are few taboo subjects. AIDS, abortion, even the death penalty have been addressed on recent episodes of House. When a death row inmate becomes seriously ill, Dr. Gregory House, the chronically cranky, pain-pill-addicted medical genius played by Golden Globe winner Hugh Laurie, rises to the diagnostic challenge. Is it a tumor, a blood disease? No, turns out the inmate ingested toxic copy machine fluid, wanting to have control over his own death.
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