A few quibbles with "Loose Ends"

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There were a few things that occurred in "Loose Ends" that didn't quite ring true for me. Did anyone else feel this way? I didn't think it was likely that a little girl with evidence of molestation would be questioned by a male doctor, especially when a female doctor was present and available. And since when does an emergency room doctor have time to read Dr. Seuss to a child during an GYN exam? This would be a social service function. I felt like the writers were ordering me to say, "Isn't Malucci sensitive and wonderful?" The patients who were waiting for treatment certainly wouldn't -- especially the guy who got fed up and stole the rig because he couldn't get treatment. Second, there have been many episodes when legal liability was an issue: having Malucci stitch the father was preposterous. Too many people saw Malucci barge into the exam room and attack him when he was on the gurney. Malucci would have been suspended immediately from a real hospital, and the place would have been crawling with social service, police and hospital legal and administrative people. Besides, if someone burst into an exam room when you were on the table and started shouting accusations and physically attacking you, would you have allowed him to show up with a suture kit and go to work on your face? Third, the petition incident with Chen and Romano was unprofessional. County hospital treatment policy is NOT determined by petition. Chen would have been much more credible if she had requested to chair a task force to research the feasibility of genetic testing on newborns and recognized the role of liability and budget -- that would have been more impressive by far, especially if anyone really wants her to get romantically involved with Romano, who would have had to respect her strength and initiative. It could also have set her up to give Kerry some competition. Four, at what point did Elizabeth forget that an adult has the right to doctor-patient confidentiality? She should never have considered contacting the mother, no matter what her emotional responses were to the anorexic girl's condition.

These are the kinds of unsatisfying moments that come with sloppy writing that plays on emotion instead of offering integrity -- a long-time strength of E.R. that has recently been crowded out. Since they usually involve the newer cast members - Cleo, Malucci, Chen, Abby - they make it hard to take them seriously as professionals. I think E.R. would be much better served by writers who focus on the clash between personal feelings and professional ethics and use it to enrich the characters, instead of trying to turn the staff into Guardians of Justice who force their personal feelings on the workplace.

-- Chessie King (chessieking@hotmail.com), May 05, 2000


Those are all really excellent points. I know sometimes on this show, we have to suspend our disbelief because some things are done for the sake of drama and trying to make things interesting. But sometimes they go a little overboard, I think.

My thoughts on the Dave story are that MAYBE he was molested himself as a child (or possibly abused in some way) or maybe he knew someone who was, and that's why he reacted so strongly about the little girl. That hasn't been revealed, and it's just speculation on my part, but maybe that's where the writers were going with that one.

I am much more annoyed by the preachy, public service announcement type storyines, like last night's rare genetic disease story with Deb and Romano. You can tell they only put those on there to lecture the audience about some illness. It takes away from the story telling quality of the show. I mean, it's supposed to be entertainment, not a documentary! I wish some of the writers would come and read the discussion boards and take the hint!

-- Melanie (msintn@hotmail.com), May 05, 2000.

Great observaations, Chessie. If the writers wanted to illustrate Malucci's tender, warm side, they should have made the situation remotely plausible; any dolt in his circumstances probably could have mustered the strength to comfort that child. A truly sensitive person has compassion for those who don't seem to deserve it at all. Malucci just seems all the more immature and, well, clueless to me now.

I also didn't get what was trying to be accomplished with Chen and Romano. It seems that Romano respects the women who can put him in his place, make him see when he makes a mistake or rush to judgement (I'm thinking esp. of Lucy); the writers needed some quicky situation in which Chen could show her gumption. But it didn't make much sense, and if it's not even in the realm of hospital protocol, then shame on the writers. (BTW, I love when those in charge of casting go out of their way to portray real families, like the mixed-race family Chen dealt with).

And I also agree w/ the point about Elizabeth. It seemed wholly out of character for her to be breaking an obvious confidentiality rule, especially since the girl did not seem in immediate danger of dying. I understand that anorexia/bullimia is a serious, often fatal illness, but it might have had more impact if the girl had OD'd on drugs, then refused treatment. I realize the point they were trying to make--Elizabeth learned of David's death and was upset about someone intentionally throwing their life away--but the anorexia situation didn't ring true enough for me. Maybe if the actress had actually looked sick and not just like she was wearing makeup to make her look pale...

anyway...our gripes with the writers continue...

-- nancy (ntc72@mailcity.com), May 05, 2000.

I think I disagree with most of these points...but not all.

First, Malucci attacking that kid's father was very believable. I think that most reasonable people would want to and would only be stopped by a level of self-restraint that Malucci doesn't have. (Why do I also get the feeling that if it was Doug doing that it would be okay?)

Why was Malucci reading to the child? Because he wanted to. It's called caring.

The point where I absolutely do agree with you was were Malucci was stitching the father. That makes no sense whatsoever.

As for Elizabeth and the anorexic, the whole story was just a set-up for her blow-up at the end. That scene made the whole story worth it.

-- Rusty Priske (rusty.priske@hrdc-drhc.gc.ca), May 05, 2000.

If there was one thing I loved about last nights episode, it was that I liked that each character did what they did instead of someone else. I liked that it was Kerry being so understanding for Carol, I liked that it was Malucci reading to the little girl (as he said, she trusted him and he probably took a liking to her. Can you imagine being six and having to have a rape test?). I liked Elizabeth was able to be such a comfort to Mark and David. I liked that Mark and David had that conversation, I liked it was Abby who used the new camera (AND DIDN'T SCREW ANYTHING UP!!!). One thing I DIDN'T like was Peter confronting Luka. Didn't need to happen, especially since Luka did everything he could. And I also liked the animal crackers.

-- Joanne (bucklind@hotmail.com), May 05, 2000.

I also agree that Chen could have taken a different approach. For once, I actually think Romano has a valid point. Hospitals cannot test newborns for each of the hundreds of genetic disorders out there on the tiny chance that they might have one. That is a simple fact, and a matter of practicality. I don't think Romano was being heartless here, he was being realistic. And it was very unfair of Chen to more or less force him to sign the petition in the presense of the boy's parents. She should have done some kind of feasibility study first and not rushed head-long into the petition. Although, it did give me a chance to see Romano's fake little public smile (the exact same one he gave to the mentally impaired girl's foster mother before suspending Kerry). That always gives me a good laugh!

-- Becky (pattonrd@muohio.edu), May 05, 2000.

Another quibble- why did everybody keep ditching the guy with the bandage on his arm? Isn't is supposed to be first come, first serve? (or something like that) First, Dave was going to see him, then Deb got rid of him to go work on the genetic boy. I guess that's the reason, though, because they had to set up her story with the genetic boy. Was it because the traumas were considered more important, and they are supposed to drop every other patient if a trauma comes in?

Probably the reason why Deb didn't consider the idea of starting a study on the feasability of doing more genetic testing is because then the writers would have to drag the storyline out into next season, and they probably don't want to bother with it.

-- Melanie (msintn@hotmail.com), May 05, 2000.

I would think any trauma coming in to the ER would be given top priority. Its a shame he had to wait so long, but I would hope these life or death situations would be taken care of first.

-- amanda (amanda.rehm@home.com), May 05, 2000.

I watched ER last night specifically for one of the reasons some of you are saying you disliked the show. I am one of those tiny chances. While I don't have MCAD, the genetic metabolic disorder that the child had on the show last night, I do have a rare genetic metabolic disorder that was picked up only because of newborn screening. Had the fact that I have PKU not been picked up during newborn screening, I would not be able to write this message. I would be mentally retarded.

The problem the show was highlighting is that right now there is a simple, cost-effective, method of expanding newborn screening to include a number of rare metabolic diseases the effects of which, if diganosed, are treatable. This expansion of newborn screening will save countless lives.

If the incidences of all the diseases that expanded newborn screening can test for are combined, the incidence for these rare diseases is approx. 1 in 3,500. They suddenly become not so rare.

I for one am glad ER highlighted this national problem. If you are interested in learning more about expanded newborn screening please look at the website http://www.tylerforlife.com. The parents of Tyler Mize started this foundation to increase awareness of the need of expanded newborn screening because their son was one of those tiny chances. He died when he was nine days old because of one those those rare metabolic diseases that only happens to someone else and their family.

-- Sarah Foster (pkuadult@aol.com), May 05, 2000.

Melanie and Chessie - the story line concerning the young boy with MCAD definitely had some unrealistic touches and of course could, and hopefully did, act as a public service announcement.

Chessie, speaking as a former nurse, I agree with your opinion on the petition incident. I was rather surprised that the writers would think that blind siding a superior in such a manner was realistic or would accomplish anything other than irritating the superior. But frankly my mother-in-law got a kick out of it, so who am I to say...the general public isn't aware of hospital decision making processes.

Melanie, as the mother of one of those children with a Fatty Acid Oxidation Disorder, the one highlighted in the preachy story line...I can only hope that a little bit of that public service info got past your annoyance and through to you...it might save your child's life one day...and if it does, believe me, you will no longer have the time to read message boards or post to them...unless it relates directly to continuing to save your child's life and the lives of others.

Television is a powerful medium that results in the education of its audience, either directly (documentaries, learning series) or incidentally (sitcoms, dramas, etc.). Regardless of whether or not the education of the audience is intentional, it occurs.

I want to thank the producers, writers and the actors of ER for their ability to artfully and knowingly blend entertainment with the education of the audience...even if you don't want to be preached to, Melanie, someday you may be very happy you watched an ER episode...and that happiness may have nothing to do with having been entertained.

-- Eileen McMullin (fodmom@cs.com), May 05, 2000.

As far as the "first come, first serve" policy...I thought about that a lot last night. The local ER here has several signs posted saying that they will try to get to patients as soon as possible, but more serious traumas may take priority, or something like that.

-- Larry B. (larrybro95@hotmail.com), May 05, 2000.

First of all, regarding Rusty's comment about Doug. Yes, I would have had a better time with Doug asking the questions for at least two reasons: he was an attending and a pediatrician. Malucci is neither. Cleo as a pediatrics intern (or something like that) and yes a woman would have seemed the more logical choice in my mind. But I will say that Malucci handled himself well with the child.

I didn't mind the "public service announcement" and in fact like the fact that I've learned so much about the science of medicine from ER. I'll never forget learning a few seasons back what caused staph infections! If the information given helps one family it was worth it. I've never cared one way or the other about Chen, but have to say I thought she was wooden last night and I didn't believe her conviction was as strong as the lines she phoned in. I thought that most of the storyline was to set Chen up with Romano for future conflict and/or romance and a small part was to deliver the information about genetic testing.

-- Diana (dilynne@juno.com), May 05, 2000.

As a matter of fact, Becky, there is a possible, very possible way, to screen for over 30 "rare" metabolic disorders. My 19-month-old, furniture-climbing dynamo is LIVING, normal, proof of that. It's $19.75 per baby, 56 cents per "rare" disorder, to be exact, and it affects almost 3,000 kids each year. Maybe even YOUR child. You do realize there've been technological innovations since the 1960's!

It's called tandem mass spectrometry and it detects over 30 "rare" disorders. Which would you prefer: your child be screened for 4 or 5 things, or 35 things? Hmmmm. For the same money, it seems my kid, and your kid, are worth running the damn blood card through the extra piece of equipment that would save almost 3,000 lives each year if it were USED ROUTINELY EVERYWHERE.

But in real life, my kid was tested and the kids in your life, most likely, were not tested. Incidentally, we have no family history. Do you? Check it out US News & World Report, January 17, 2000 www.usnews.com/usnews/issue/000117/nycu/babies.htm

-- Wendy Nawn (wendynawn@malvernconsulting.com), May 05, 2000.

Emergency rooms do not operate on a first come, first served basis. They deal with the more emergent cases first. Thats what triage is all about. (I think.)

-- S. Trelles (trelles@ix.netcom.com), May 05, 2000.

I thought it was about time that expanded newborn screening got some prime air time. I also wish it would have happened about 3 1/2 years ago. We almost lost my nephew to one of these disorders, Isovaleric Acidemia (IVA) because we weren't offered this simple, inexpensive test. My nephew IS worth $25 and a whole lot more. My nephew had to have an acute attack at 2 weeks old before they figured out what was wrong with him. But he was lucky to have fast thinking doctors that diagnosed him before any permanant damage was done. Other's haven't been so lucky. AWARENESS, AWARENESS, AWARENESS! That's what it was about. And I think the writers, actors and producers of ER did a fantastic job raising awareness, especially with the time they had to work with. One day someone you know and love will be saved by this very awareness. Then you'll be glad you watched and wish you hadn't been nit-picking. Teri

-- Nephew with IVA (trose@olypen.com), May 05, 2000.

Kudos to those of us who are supporting the Newborn Screening/MCAD storyline in the May 4 episode of ER and SHAME on the rest of you! MCAD is just one of the devistating disorders that can be screened for with tandem mass spectronomy - a simple blood test requiring only a few drops of blood on a card at an even simpler price of $25 from Neogen in Pittsburg, PA. You can visit Neogen's website at www.neogenscreening.com for more information. It absolutely amazes me that as parents we have no problem spending hundreds of dollars on gadgets to keep our babies safe (that's not to say some of them are not absolutely necessary) but some have a hard time spending a mere $25. in order to SAVE the lives and/or the physical and metal development of the most precisious and weakest members of our society. Whether one of these disorders has been diagnosed in your family before or not is mute. I have 2, count 'em 2, beautiful little boys with PKU (an amino acid disorder treated through simple diet and an special amino acid formula). There is not one case of PKU in either my family or my husband's family that WE KNOW OF. It's only been 40 years +/- (2 generations) that we have been able to screen for even some of these disorders. Some tests for other disorders are even newer. How could we possibly know of a family history of something we didn't even know about more than 2 - 3 generations ago. These are RESESSIVE GENETIC DISORDERS, folks. That means they can can go undetected through generation after generation not being found until you, your brother, sister, cousin, etc. happens to marry someone who also carries the recessive gene. I don't know the stats for other disorders, but PKU occurs in 1 out of every 10,000 live births. It knows no boundaries of sex, race or religion. 1 out of every 2500 people carry the recessive gene for PKU and don't even know it. Other disorders have other numbers. Some, like PKU can cause mental retardation and other neurological effects like seizures if left undiagnosed and untreated for the first few months of life. Others will cause death within days or weeks of birth if not diagnosed and still others (like the little boy with MCAD on the show) can go undiagnosed for years without any apparant physical or mental effects. THIS CAN EFFECT YOU AND YOUR FAMILY! So I challenge you all to re-evaluate your opinions of this annoying, pushy, public service announcement. Public service announcement? YES. Absolutely necessary? Not yes, but HELL YES!!!

-- Denise Rogers (rrogers@glasscity.net), May 06, 2000.

I think the people who have posted to this thread about the "Public Service Announcement" quality of the newborn-screening storyline aren't really hearing each other. No one has denied the need for screening and the benefit that can come from early detection of genetic disorders. No one is unsympathetic to those families who have to cope with the presence of genetic disorders in their loved ones. What the "negative" comments have tried to convey is annoyance that the storyline was handled in such a preachy, unrealistic way. The story could have been extended to show Chen's continued commitment to secure the screening as routine at County General, and possibly draw E.R.into more involved, intelligent stories than letting this one die as a power struggle between Chen and Romano. In an age of managed care, budget is emerging as a factor in health care that often handicaps doctors in serving their patients. E.R. could do a tremendous service by illustrating this conflict and the impact it has on individual lives, instead of trivializing it as a throwaway plot device. It could also serve to alert parents to seek the testing for their children by putting faces and names on the problem in strong stories, instead of having a character give a speech and then drop the subject.

-- Chessie King (chessieking@hotmail.com), May 06, 2000.

Thank you, Chessie, for making that point! ER has a habit of doing these one-shot storylines where they will talk about one issue or one disease during one episode, then you never hear about it again. I am looking at this from a dramatic point of view - the quality of the writing and acting on the show. If they would do a better job of developing the characters, they could show how issues like that affect life in a real hospital, and it would be a good idea for Chen to continue to convince the hospital to offer the tests. But then the writers would actually have to continue the storyline into next season, and they probably don't want to mess with it.

Look at it this way- ER may be the #1 rated show in prime time, but they still only get around 18 to 20 million viewers a week. (sometimes more) But in a country of about 280 million people (I think that's around what we have now) that is still a LOT of people who don't watch ER every week, and will not hear the message. If it is so important to educate the public, then do stories about it on the evening news with Peter, Tom, or Dan, or 20/20, Dateline, PrimeTime Live, not to mention USA Today, Newsweek, local newspapers, etc. etc. And how about public schools, colleges & universities? These would be much better sources for informing a LOT more people. And why aren't more doctors and OB/GYNs telling their own patients about these genetic tests? It seems to me like a REAL doctor should be the best source of information about these things.

I'm still not going to change my opinion that I think the way these storylines are presented is very annoying. The writers could do the storyline in a way that would make it seem like a real conversation that would happen between a doctor & patient in a real hospital, and they could continue the story longer than just having one little 5 minute snippet in one episode. Instead, they just have the actors give a little speech about it, aimed directly at the audience, then they drop the subject. No offense to anyone here, but if I ever did have kids, I would try to inform myself about everything I would need to know and I surely would not rely on a TV drama for the important stuff. I would be much more angry at any real-life doctor who never bothered to inform me that I could have an inexpensive test to rule out genetic diseases!

-- Melanie (msintn@hotmail.com), May 06, 2000.

A word on the "first come first served" thing. A real ER has a "triage nurse" or "triage officer" who reviews EVERY Patient who comes into the ER (whether they walk in off the street, or come in via an ambulance.. the ambulance priorities are often done over the radio prior to arrival). That person decides who gets treated first. ER the show, of course, doesn't have such a thing (probably because it's more dramatic to have the paramedics barge in and someone shout "What've we got?")

-- Lynn (lynn@wordsmyth.org), May 06, 2000.

About the triage thing; remember in season 5 when Genie had Hepatitis c? In the eppy with the priest/father, Kerry asks Genie whether she wants to do heavier work, but Genie says she'd rather just do triage. When I went to a hospital for a wound (which is why I empathised with the wound check guy!), a triage nurse reviewed my case, gave me some water, told me not to touch my wound and then didn't see me for two hours. So there:) But at least I didn't steal a rig!

-- samira (matb_west@chickmail.com), May 06, 2000.

Good idea, about getting info from real-life doctors. PROBLEM is real-life doctors don't know. There's been press on this for only 4 months. The technology's been around well over 15 years. That says to me, asking the doctor isn't quite the answer. Just ask parents who celebrate their kids' birthdays at their gravesites. Do you see the problem? Of course you don't, it won't happen to you.

-- Wendy Nawn (wendynawn@malvernconsulting.com), May 07, 2000.

Personally, I like when they do the PSAs on ER. I've always thought that TV, while entertaining the audience, should teach them something. ER does that in a non-heavy, very entertaining way, and they manage to get the point across without seeming like those educational videos they show you in high school. Just think, I know that ER only gathers about 19-20 million out of 250+million, but still, if one person knows, they usually pass the info to atleast two or three other people etc, so I think it is effective for a medical drama to include these kinds of PSA's.

-- samira (matb_west@chickmail.com), May 07, 2000.

I agree that ER could expand this story line and show Chen's "continued commitment" for expanded newborn screening, which is why many of us have begun writing letters to the producers of ER to encourage them to do just that. We have also supplied them with ideas on how to make it more (I guess you could call it) viewer friendly and realistic. Chessie if you really believe your words about "continued commitment" you could join us and write a letter of your own to the ER producers, you'd be helping to raise awareness and could urge them to make the changes in plot handling that you feel are needed. Warner Bros. TV ~ ER, 4000 Warner Blvd., Building 133, Rm. 204, Burbank, CA 91522. Every voice counts! And we don't want to see the subject dropped either... For more information on the Tyler for Life Foundation and it's efforts please visit our website at www.tylerforlife.com On the subject of budgeting and costs, in a press article found 4/9/00 in Pioneer Planet, Gary Hoffman, the manager of the newborn screening laboratory in Wisconsin, believes that "the medical community, insurance providers and the government will save $500,000 a year by early treatment" Early treatment can only come by way of early detection i.e. expanded newborn screening done by Tandem Mass Spectrometry. On the subject of getting the word out via "Peter, Tom or Dan" Dan Rather has done a segment on newborn screening and we're always working to get the word into the public by any means available whether it be 20/20, Dateline, PrimeTime Live, Newspapers, State Health Depts or ER. Everytime just one person's awareness is raised a good thing has been accomplished. And I, myself, am working on raising the awareness of the doctors and hospitals in my state,(since many are still unaware of this technology). So when Washingtonians go to their OB's, the doctors will have this information to share. In fact all doctors I've educated so far are now encouraging 'new parents to be' to have this testing done, but doctors have to KNOW about it before they can share the information or use the technology.

-- Teri (Nephew with IVA) (trose@olypen.com), May 08, 2000.

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