ER Season 14 Episode 5: Under the Influence

Janet: You drank? When? Last night. You want to get to a meeting?

Abby: I don’t have time to go to a meeting. I don’t need to go to a meeting. I just I had a bad day, a very bad day, and it was just one time. I’m not going to start drinking again.

Janet: Really? Are you an alcoholic?

Abby: Yes, but..

Janet: Yes, but? All those years that you were sitting in meetings, were you an alcoholic then? Yes or no? OK, keep drinking. Do the research, see what happens.

Abby: I can handle this.

Janet: Just let me know how it works out for you. OK, I’ve got a clinic full of patients.

Abby: Janet, Janet, you’re my sponsor.

Janet: I was your sponsor, but now it’s very simple. If you’ve decided you’re not an alcoholic, I can’t help you. If you are, I’ll be your sponsor again and I’ll support you in recovery. Let me know what you decide.

This conversation between Abby and Janet reminded me of an internal dialogue I have with myself a lot – debating whether or not I really have an eating disorder, and thus whether or not I really need to follow my meal plan. My therapist often likens restricting a few exchanges to an alcoholic having one drink. Much in the same way that Janet responds to Abby, if I restrict a little she tells me that I need to get back on track ASAP, that it is a slippery slope. Too often though, I rationalize, just like Abby is doing here. I say that it’s not a big deal, that it could be worse, and that I’ll get back on track tomorrow. Kind of like Abby, I say “yes, but…”. There is always a “but.”

Sometimes though, the rationalizing goes even further. I’ll convince myself that I don’t really have an eating disorder – I’m not underweight, I’m eating enough, I’m not overexercising or purging etc. Then, the logic goes, if I don’t have an eating disorder, why do I need to follow this meal plan? Why do I have to keep eating even when I’m full, or make sure to be diligent about meals/snacks? Normal people don’t eat the same amount every day, so why do I have to follow this meal plan?

The problem is, as Janet points out, this doesn’t end well. As she says, “do the research, see what happens.” Just like an alcoholic eventually starts drinking more than one drink, I start restricting more than one exchange. One exchange becomes two, two becomes three, and then those three never come back. I think Janet’s point to Abby is that she has to recognize that she has a problem and that she has to take certain steps (perhaps going to a meeting), to overcome it. In the same way, I need to stop rationalizing and accept that I need to follow my meal plan in order to achieve recovery.


When You Least Want It

From ER Season 8, Episode 7 “If I Should Fall From Grace”:

Carter: Want to tell us about the scars?

Grace: I used to be a cutter…I developed an eating disorder. It was my way of dealing with stress….

Lewis: And what about now, are you still cutting?

Grace: No.

Carter: Show me your arm….Grace you have a fever…maybe from an infection. Maybe from using a dirty blade. 

Grace: I told you I haven’t eaten.

Lewis: So the eating disorder continues?

Grace: No! I’ve just been cramming.

Carter: Let me see your thigh.

[Lewis lifts up her skirt, revealing fresh cuts, and Grace becomes angry]

Lewis: We just want to help.

Carter: If you don’t stay and agree to speak to somebody, you are going to force me to put you on a psych hold.

Grace: Stop. You are blowing this way out of proportion. Why are you doing this?

Carter: Because I know what it’s like to need help when you least want it.

Grace: Please just leave me alone.

Carter: I can’t.

I love Carter’s line “because I know what it’s like to need help when you least want it.” For those who are not familiar with the show, in Season 6 Carter developed a drug problem after being nearly fatally stabbed. He was confronted by the rest of the ER staff and ultimately went to rehab.

I wish I could find a clip of this scene online because the transcript really doesn’t do it justice. Noah Wyle (the actor who plays Carter) does a great job delivering the line with sincere empathy. I love the way he tells her that no, he can’t just leave her alone.

As much as I can be resistant to help, I am very grateful to all the people who continue to stick by me, and help me even when the eating disorder is fighting back and I appear not to want it. I know for me, it’s often when I least want support that I need it the most.

Stop Being On Hold

ER Season 9, episode 15, “A Boy Falling Out of the Sky”:

Abby:  You know, my life is on hold…It will always and forever be on hold. You don’t wanna be on hold.

Carter: Don’t put it on hold.

Abby: I have no choice.

Carter: You do…Right. Your life sucks. There’s nothing you can do about it [sarcasm]…I want you to stop being so afraid.

I was watching this episode last night with some friends, and Abby’s claim that her life is on hold, with Carter’s challenge to her that there is nothing she can do about it, really stuck out to me.

At the risk of oversimplification, Abby claims her life is on hold and will forever be on hold because of the history of bipolar disease in her family. She is constantly waiting for bad news to come, and she also claims that she attracts misery wherever she goes.

Carter, however, challenges her assumption that she is a passive by stander with his comment about there being nothing she can do about it. He challenges her to stop being afraid of bad news, and to basically start living despite her fears.

I think the reason this quote really stuck out to me right now is because I struggle with feeling like my life is on hold because of the eating disorder and depression. There is a part of me that feels like things need to be going a whole lot better than they actually are in order for me to move forward. However, what I am learning from my wonderful therapist, as well as experience, is that waiting around doesn’t really work. Not to be too corny, but recovery is all about building a “life worth living”, and it’s hard to stay motivated with recovery or figure out what you want in life if you are just waiting for things to get better.

That’s not to say that you should rush into things or try to work full time while doing treatment or something. However, I think that when it comes to figuring out how to build a life, sitting down and making pros and cons lists falls way short of building experiences that help give you and idea of what you want. Right now I have some big decisions to make about my future, and I feel paralyzed. It’s really tempting to crawl back into the grips of the eating disorder, or lay under the covers in the grips of depression. These decisions I have to make will really push my life forward in a way that it has not been for the last few years. I will really be taking any hold button off with these decisions, and that’s scary. But, ultimately I know that it is for the best, and the best way to make these decisions is to keep pushing forward, rather than moving backwards. Just as Carter suggests, I do have the power to change things.

Asking for Help

From ER Season 9, Episode 11 “A Little Help From My Friends:”

Carter: Look, self-sufficiency’s a good thing, but it’s not the only thing. Asking for help when you need it doesn’t make you weak.

I could write a blog post just based on the title of the episode alone. I have the best friends, but I am not always the best at asking them for help. I keep trying to remind myself that since I feel good when I am able to help out my friends, they probably feel the same way. Thus, I should not shy away from asking for help.

Along those lines, Carter’s quote is pretty self-explanatory, so I’m not going to write too much about it. But, I do think it is worth emphasizing the latter part – that asking for help when you need it doesn’t make you weak. I think we live in a culture that really emphasizes self-sufficiency. As Carter says though, that is not the only thing.

Personally, I think it is actually a sign of strength to ask for help. It is far more scary to open up to someone and admit that you are struggling than remain under the illusion that everything is fine. Now, I just need to get my brain to remember that the next time I need to ask for help!

ER quotes

Some ER quotes that I just found:

“Once something gets in my way, it’s like a chemical reaction. I just shut down, and I give up. I’m just looking for an excuse to stop.” ~ Abby, ER

I don’t think I shut down the second something gets in my way when it comes to work or school or anything, but I definitely do this with the meal plan.  If something gets in the way of me following the plan, rather than going out of my way to make sure I stay on top of things, I kind of throw my hands up and go “well, guess that’s not going to happen.”  As Abby says, I’m just looking for an excuse to stop.  My therapist and I have been talking a lot recently about needing to create a “new normal”, where I make getting in 100% the priority, as opposed to looking for outs or excuses.

Abby: I see how hard you’re throwing yourself into the job, Carter.
Carter: It’s a hard job.
Abby: So’s sobriety.

Just a good reminder that recovery from drugs, alcohol, eating disorder whatever, is hard work.

20 Years of ER

This year marks 20 years since the television drama ER premiered.  While I have not blogged before about the show, it was the first show that really “hooked” me; the first show that I would watch for hours on end.  It also really sparked my interest in entertainment education, or how TV shows and other forms of media can be used for educational purposes.  With that in mind, here are some studies that have been done through the years on ER and its ability to teach people and impact people’s views of healthcare. This is not meant to be a comprehensive list, although I did try to find as many as possible!

First, I would like to promote a book that I helped update a few years back called Playing Doctor: Television, Storytelling and Medical Power, by Joseph Turow.  The updated version looks at the landscape of medical TV shows since the book’s initial publication 1989.  For the updated version I watched episodes of ER and cataloged the time spent on different topics, such as ethical or health policy issues.  The book discusses how ER really ushered in an era of portraying doctors as human beings with flaws rather than god-like creatures, and also how it influenced the creation of many more doctor shows such as Grey’s Anatomy and House M.D. Check it out 🙂

Moving on, here are some studies that look at ER in the context of entertainment education:

1) An alcohol message beneath the surface of ER: how implicit memory influences viewers’ health attitudes and intentions using entertainment-education (2014)

2) Medical dramas on television: a brief guide for educators (2013)

3) Teaching Health Literacy Using Popular Television Programming: A Qualitative Pilot Study. (2010)

4) Medical and nursing students’ television viewing habits: potential implications for bioethics (2008).

5) Entertainment-education in a media-saturated environment: examining the impact of single and multiple exposures to breast cancer storylines on two popular medical dramas. (2008)

6) How an ER Storyline Helped Pass the Patient Navigator Act (2007)

7) Evaluating a Minor Storyline on ER About Teen Obesity, Hypertension, and 5 A Day (2007)

8) Embedding Health Messages into Entertainment Television: Effect on Gay Men’s Response to a Syphilis Outbreak (2005)

9) Entertainment Education and Health in the United States (2004).

10) Communicating Health Information Through The Entertainment Media (2001)

11) The “ER” Seminar: Teaching Psychotherapeutic Techniques to Medical Students. (2001)

12) The role of the television drama ER in medical student life: entertainment or socialization? (1998)

13) Throw that epidemiologist out of the emergency room! Using the television series ER as a vehicle for teaching methodologists about medical issues. (1997)

And here are some studies on the reality of ER:

1) An assessment of resuscitation quality in the television drama Emergency Room: guideline non-compliance and low-quality cardiopulmonary resuscitation lead to a favorable outcome? (2014)

2) ER vs. ED: A Comparison of Televised and Real-Life Emergency Medicine (2013)

3) Depiction of seizure first aid management in medical television dramas (2011).

4) The depiction of illness and related matters in two top-ranked primetime network medical dramas in the United States: a content analysis. (2010)

5) Resuscitation on television: realistic or ridiculous? A quantitative observational analysis of the portrayal of cardiopulmonary resuscitation in television medical drama. (2009)

6) Cardiopulmonary resuscitation on television. Miracles and misinformation. (1996)

Happy Reading!