Showtime Edie Falco stars in the Showtime series “Nurse Jackie.”
Let me put my opinion up front, right at the start: I loved the new Showtime series “Nurse Jackie,” and then I didn’t.
The
first several episodes show Jackie managing the swirling emotions and
complicated medical issues of an urban emergency department with
compassion and a high degree of expertise. She knew when an injured bike
messenger needed a CT scan. She could be empathic with a patient who,
just minutes before, had slapped her, hard, across the face. She gave
detailed instructions about medications to a young girl caring for her
mother, who had lupus. She seemed like a real nurse, and I was impressed
that the show could portray nursing so accurately.
As the series
continued, though, it started to look more and more like “General
Hospital” and less and less like a real hospital. We discover that,
improbably, Jackie and Eddie the Pharmacist have been having an affair
for a year, yet he has no idea that she’s married. Another character,
Dr. Cooper, fails to show up to certify a death for organ donation
because he’s, um, busy in a meeting room with his new girlfriend. Jackie
resolves an argument with Dr. Cooper, whom she mostly loathes, by
kissing him.
Jackie is particularly controversial in nursing circles because of her drug use.
At
the start of the series Jackie’s use of prescription painkillers was
used for dramatic effect (for example, crushing Percocet to sprinkle
into her coffee). But, in my view, the series is at least acknowledging a
very real problem among nurses: chronic back pain.
“What do you call a nurse with a bad back?” Jackie asks in a voice over as the series opens. “Unemployed.”
Nurses suffer the highest incidence of work-related back injuries
compared to any other profession. Lifting and turning patients, who,
incidentally, are becoming increasingly heavy, puts a constant strain on
a nurse’s back.
Jackie has a bad back, and her pain issue appears
to have led to chronic use of opioid pain relievers, which the show
suggests has become a coping mechanism as well as a form of pain
control.
But how can Jackie function if she’s taking so many
drugs? The reason people on chronic opioid therapy can function well is
because they develop tolerance to many of the adverse effects of the
drugs, including sedation and euphoria. A person who hasn’t been using
the drugs could take a small dose and experience a high or euphoria. But
people with chronic pain, who have developed a tolerance for opioids,
can take large doses of narcotics without the drugs making them loopy.
Undertreatment
of pain in the United States is a serious problem. Given how strictly
narcotics are controlled here, it’s certainly plausible that a doctor
would refuse to prescribe the dose of narcotics Jackie needs to relieve
her pain.
But what doesn’t seem plausible is that Nurse Jackie is
taking large doses of Percocet. Percocet is a combination of the
painkiller oxycodone and acetaminophen, the ingredient in Tylenol.
Acetaminophen has the potential to cause liver failure in a patient who
ingests more than 4 grams over a 24-hour period. A government health
panel has recently recommended that Percocet be banned.
Given the
amount of Percocet the character Jackie crushes and snorts on a daily
basis, she’s well over the safe limit for acetaminophen. It’s doubtful
that any nurse as competent as Jackie obviously is would be so stupid
with her drugs.
In various forums (including this blog), nurses
who are critical of the program also made much of Jackie’s unethical
behavior in the first episode. She flushed a patient’s ear down the
toilet and stole money from the same patient that she later gave to the
pregnant widow of another. In my view, these scenes serve as snapshots
of Jackie’s play-by-my-own-rules morality. They also set up the show’s
“Is she a sinner or a saint?” dichotomy.
I doubt any nurse would
so repeatedly, and so consciously, put her license at risk. I’ve never
worked in an emergency department, but Jackie’s choices struck me as too
risky to be realistic. Still, having Jackie confront those choices
shows the moral dilemmas nurses find ourselves in on an ongoing basis. I
imagine that in the emergency room such moral dilemmas are intensified
since patients come to the hospital straight from their own lives,
needy, confused and often desperate for relief.
The episode
“Nosebleed” aired most recently and for me marked a shift from the show
being about a complicated and troubled person who really is a great
nurse, to being less and less about nursing and more and more about how
Jackie’s life, and her nursing career, are both spinning out of control.
I
suppose it’s good television, but if Jackie’s going to live out a soap
opera — albeit one that is well written, with compelling personal
stories — why make Jackie a nurse? The life and death nature of her job
shouldn’t become background to her personal foibles.
Because
here’s the thing. Sure, there are nurses who have affairs, maybe even in
the hospital (though most nurses wouldn’t have time — just as most
nurses wouldn’t have time for Jackie’s sit-down lunches in restaurants).
There are nurses who are addicts, just like there are addicts in all
professions and walks of life. But when the failings of a nurse as good
as Jackie threaten to compromise her ability to do the job, she stops
being a nurse.
Edie Falco is a great actress, and I have a soft
spot in my heart for Jackie. I hope she returns on the second season to
lick some of her personal demons, but more than that, I hope the show
abandons its dip into melodrama and returns to its roots in the drama of
the hospital. Nursing is all about the agony, the ecstasy and
everything in between. The show’s writers need to trust their source
material — and their fabulous star — and put the Nurse back in “Nurse
Jackie.”
Correction: An earlier version of this post incorrectly described why chronic opioid users can function at a high level.
