Monday, July 6, 2009

HawthoRNe and Palliative Care

Ok, I had no intention of watching a new television series (I already have way too many stored on the DVR). But after catching the first two minutes of the HawthoRNe episode "Yielding" in which they speak of discontinuing a patient's life support, I had to keep watching. I guess my curiosity got the better of me. Below is the first two minutes I was speaking of.

For those of you not familiar with this new TNT series, it centers around the Chief Nursing Officer, Christina Hawthorne (and the cleverly capitalized RN in the title is all TNT, not me), played by Jada Pinkett Smith. Hawthorne just lost her husband about a year ago and this series deals with her personal life as a new widow and now single mother along with her work as the CNO.

This episode focuses mostly on an elderly woman who has been on the ventilator now for 10 weeks and the hospital is feeling the pressure to get her extubated because they need the ICU bed. My first issue with this episode comes when they are speaking with the patient's son. They tell him that when there are no brain waves there is no chance for recovery. A correct statement but hmm... Is she brain dead?

The son asks for just 24 hours more to come to grips with things then he will take her off the life support himself(they offer to help him with it but he wants to do it himself). But the hospital needs the bed. So Hawthorne sets a storage room up to house the ventilated patient and thus give the son 24 hours more. A storage room complete with a shorting out power strip to plug the vent into. Again, hmm...

Meanwhile, a seemingly uncaring daughter enters the picture and demands the patient be taken off the life support right now as the patient had stated she did not want this. She goes to the cold hospital administrator type who demands the plug be pulled. (Is there an advanced directive? Or was it just a verbal thing? That was unclear to me.)

The biggest issue though was the very strange way of they had of removing "life support". They turn a dial and the patient's pulse and blood pressure drop (but you could still hear the vent going). Then they turn it again and the pulse and blood pressure drop further (vent sounds still present) and you hear the flatline. Hmm...

But even though Hawthorne wasn't able to grant the sons wish, it all ends ok. We find out later, the son had gotten a chance to come to the patient's room and say goodbye and the evil daughter cries when they told her her mother had died.

The title I started with for this post was "HawthoRNe and Palliative Extubation" but as I was writing I realized that they never say the word extubation and that is indeed not what they do. They say "remove life support" and "pull the plug" and it is all done with one dial. I do applaud the writers of Hawthorne trying to address end of life issues and the sentiment is there, but the attempt left me a bit confused. It seemed to be focused more on the stereotype of what people think "life support" is than any medical facts. I realize that the sentiment was really the whole point, but I couldn't get past the poorly done technical parts.

The episode had some other issues (nurse in hot pants doing drug inventory). The characters seemed stereotypical and the other plot lines were predictable. Some of the acting wasn't great. I think this may be the one and only time I watch HawthoRNe but I would be interested to hear what others, in and out of the medical field, think.

6 Responses to “HawthoRNe and Palliative Care”

Cyndi Cramer, BA, RN, OCN, PCRN said...
July 7, 2009 at 4:30 AM

A lot of nurses are "up in arms" about this show. Whoever heard of a CNO (or Director of Nursing) who starts IV's, is constantly involved at the bedside, etc...?
I watched the 1st episode and a male nurse (who really wanted to be an MD but flubbed the entrance exam--hmmm) had to follow an MD order that was wrong because he was "just the nurse" (I don't think that works in court...hmmm)and then got in trouble and the doc did not...hmmm
Even though they seem to be trying to make nurses "look good"..that was really really stupid...
Wouldn't have expected them to do any better with palliative care...


Amber Wollesen, MD said...
July 7, 2009 at 7:19 AM

Cyndi,
So glad to have a nurses opinion. When I saw the nurse in hot pants, I thought that if I was a nurse, that would have offended me. There was also a comment in this episode made by the administrator guy to one of the doctors like "are you having trouble controlling this nurse?" talking about the CNO!
Of note, I did look up who the medical consultant was and it is Dr. Armand Dorian who is an ER doctor and does a lot of consulting work. Maybe he is just a name on the credits. I hope that's the case because if he thinks that show was accurate, he needs to go back to school. (I know that sounds harsh but why even have a consultant if things are going to be that bad?) http://www.imdb.com/name/nm2720656/


Amber Wollesen, MD said...
July 7, 2009 at 7:21 AM

Oh, the link I posted is to Armand Dorian's imdb listing. And thanks for your comments Cyndi!


geriatricare said...
July 11, 2009 at 4:05 AM

Two interesting articles in this respect:

http://news.nurse.com/article/20090112/NATIONAL02/101120088/-1/frontpage

http://www.nurseweek.com/news/features/00-10/tv.asp

-grtz Bram


Deirdre Hulihan NP said...
July 11, 2009 at 9:09 AM

I am a palliative care nurse practitioner and worked as a hospital RN for many years. I was looking forward to the possibility of a good nurse show, but HawthoRNe is a huge disappointment. I hated the, "Are you having trouble with this nurse?" remark, and that it went unaddressed by the CNO. I thought that putting the pt in a storeroom was absurd and showed very poor judgment on Hawthorne's part. The daughter was realistic, but they made her (and the administrator) so cold that her point was lost. She was the only one on the show advocating for the patient! Toward the end of the program the doctor was the one to point out that it is our job to advocate for the patients, not their families. The great white (doctor) knight enters to explain it all to the poor emotional nurse. (sigh) No one is really busy in this hospital; they're all just gearing up for their next "clever" line.
I like your comment, "why even have a consultant if things are going to be that bad?" I will add: why have a physician consultant for a show that's about a nurse?


Deirdre Hulihan NP said...
March 16, 2011 at 11:53 PM

I am a palliative care nurse practitioner and worked as a hospital RN for many years. I was looking forward to the possibility of a good nurse show, but HawthoRNe is a huge disappointment. I hated the, "Are you having trouble with this nurse?" remark, and that it went unaddressed by the CNO. I thought that putting the pt in a storeroom was absurd and showed very poor judgment on Hawthorne's part. The daughter was realistic, but they made her (and the administrator) so cold that her point was lost. She was the only one on the show advocating for the patient! Toward the end of the program the doctor was the one to point out that it is our job to advocate for the patients, not their families. The great white (doctor) knight enters to explain it all to the poor emotional nurse. (sigh) No one is really busy in this hospital; they're all just gearing up for their next "clever" line.
I like your comment, "why even have a consultant if things are going to be that bad?" I will add: why have a physician consultant for a show that's about a nurse?