An American remake of a popular British TV series debuted Sunday, November 24. A late-night HBO comedy built around the idiosyncrasies of hospital extended care might seem like a strange idea, but we watched, and it does work.
(In fact, one has an inkling that the premise might actually be more believable in today’s U.S. healthcare climate than in any other time or place.)
Staff of the Billy Barnes Extended Care Unit of Mt. Palms Hospital in Long Beach, Cal., looks after aging female patients suffering from dementia, incontinence or heart problems. Meanwhile, staff themselves struggle with a broken healthcare bureaucracy and many of the issues facing real healthcare providers today.
The real healthcare/long term care issues at stake
The pilot episode “Born On The Fourth of July” deals with the universal themes of death, aging and breaking news of a loved one’s death to relatives. In fact the episode opens with 87-year-old “Lillian” already passed away in her hospital bed, with a birthday cake waiting at her bedside, untouched, and closes with Nurse Dawn (Alex Borstein) breaking this news to Lillian’s older sister in a surprisingly poignant scene.
Even in very old age, death can be unexpected and has real emotional consequences.
Meanwhile nurses and doctors deal with smaller but no less real issues. Mt. Palms is on the brink of losing Medicare reimbursement due to cleanliness violations, and patients on the ward struggle to understand their Medicare and Medicaid coverage, all the more difficult to explain given that many are experiencing cognitive decline.
Dr. Jenna James (Laurie Metcalf), committed to research and publishing studies, spars with nurses who think that patient care should take priority. James chases errant turds al over the hospital, hoping to add them to her “stool collection” for a “conference in Cleveland next month.”
“In this day and age, do you really think there are only seven categories of stool?” – Dr. Jenna James on her dream of expanding the Bristol Stool Scale from seven categories to 16.
While unclaimed feces floating about is a rather lighthearted problem, it could pose a real danger for hospital-acquired infections like Clostridium difficile, which the nurses mutter in hushed voices rather like a Hogwarts student might say “Voldemort.”
The nurses struggle to care for a new patient, picked up on the street – a case of “granny dumping,” perhaps – who does not speak English. Language barriers and access to healthcare is a real issue in hospitals today, and a shortage of medical translators further complicates the nurses’ efforts.
The hospital staff also struggles with limited bed availability, a symptom of hospital overcrowding. James even rushes the release of a patient who may not be able to care for herself independently in an effort to free up her bed for a prostate cancer patient, one of the darkest moments in the episode.
“You flushed away an important lump of information.”
The fact that extended-care workers are often thought of as “less than” other hospital staff will likely be the issue that defines this show in future episodes. Other hospital personnel call the Billy Barnes unit a “dead end” and say, “nobody with any self respect would take this job.” One doctor temporarily working on the unit tells a patient “I don’t only work here, I’m also a real doctor.”
That within-medicine hierarchy of respect hasn’t been explored in pop culture to date.
Is it a good show?
We’re working with a limited amount of evidence at this point, but tentatively, yes. The show’s lighthearted attitude about death may shock at first but soon feels like the only way to deal with working in an extended care ward day in and day out.
Lest we forget, “Getting On” is a comedy. We can decode its attitude toward aging and death through humorous scenes, like chasing the owner of an errant turd left in a chair in the waiting room. We also see it in meta details, like the carefully selected cast culled from award-winning comedies of the last 20 years, from broadly successful sitcoms to cult-inspiring web series.
Laurie Metcalf won three Emmys for “Roseanne.” Alex Borstein gained fame as a sketch player on “Mad TV,” later lending her voice to “Family Guy.” Niecy Nash, as compassionate Nurse DiDi, the emotional heart of the show, surprises viewers who remember her from the irreverent Comedy Central show “Reno 911!” And a sharp eyed viewer will catch Helen Slayton-Hughes, who stole the show as a bit player in “Burning Love,” in the final scene as Lillian’s devastated sister.…