close reads

The Doctors Made ER Great. The Nurses Made It Radical.

Photo: NBC

When ER first premiered 25 years ago, prime-time medical dramas were not new on television. There was Casualty and St. Elsewhere in the 1980s, and earlier shows like Dr. Kildare, Marcus Welby M.D., and Medical Center. And after ER, there was a small boom of medical shows: Scrubs, Grey’s Anatomy, Private Practice, House, The Resident, Code Black, New Amsterdam, The Good Doctor. Grey’s Anatomy has been a fantastic show. Scrubs was beloved. The Good Doctor is quite popular. But ER was the best of them. It’s not just the best medical show TV has ever had; its early seasons contain some of the best episodes of TV ever.

Like nearly all medical shows, ER’s greatness comes from the brilliance and the humanity of its protagonists, most of whom were doctors. The show can be divided into major eras based on the arrival and departure of the doctors: the year Susan Lewis (Sherry Stringfield) left, the end of the age of Doug Ross (George Clooney), the arrival of Abby Lockhart (Maura Tierney), the reign of Sam Taggart (Linda Cardellini), the return of Noah Wyle’s John Carter. There have been a lot of great TV doctors, on ER and on lots of other shows. But the most radical thing about ER — the element of the show that no subsequent medical show has replicated or improved upon — is that it was always also a show about nurses.

ER is hardly the only medical show to feature nurses, of course — there was a whole show in the ’60s called The Nurses, and nurses have always been a part of General Hospital — and many of the shows shows that followed ER have had prominent nurse characters. But there are some recurring tropes about the role of nurses in medical shows: They are often the repositories of wisdom, the characters new medical students turn to when they’re out of their depth. This is the role of Carla on Scrubs, who wryly but helpfully tutors JD and Elliot when they first arrive at Sacred Heart. It’s a plot that happens a few times on Grey’s Anatomy, especially whenever the show imports a new batch of med students to fill in for whatever characters have died or moved away over the last season. A character with the unlikely name Nurse Fryday shows up for three episodes to stop Dr. Murphy from ordering too many tests. Nurses on TV also tend to show up in ones or twos — Carla and Laverne are the only nurses to play a major role in Scrubs, and of them, only Carla is given her own stories. Then there’s the trope of the nurse character as a love interest for doctors: Nurse Eli has a brief fling with Dr. Bailey on Grey’s Anatomy. Dr. Taub has a love child with one of the nurses on House. Nurses are occasionally ball busters or rabble rousers. (On New Amsterdam, the nurses staged a walkout but almost none of these nurse characters have names.) Nurses are almost always secondary figures, in other words. They tend to be marginal, expendable, interchangeable, or primarily there to support the development of the doctors.

This was not the case on ER, pretty much from the jump. The first scene of the first episode of the series is a familiar one, a concept the show repeated many times, and which has been replicated on many shows: Anthony Edwards’s Dr. Mark Greene is sleeping in the on-call room and a nurse wakes him up to tell him he’s needed. The story that follows is mostly about Dr. Greene, but the woman who wakes him up is not anonymous — her name is Lydia Wright. Played by Ellen Crawford, Lydia has a personality and recurring stories; she has ongoing friendships with several of the ER staff; and she appeared on 113 episodes over ER’s total run, which included an entire arc about Lydia’s engagement and wedding.

If you think about Lydia compared with many other long-running ER characters, she’s pretty unremarkable. She was on fewer episodes than other nurses like Haleh (Yvette Freeman) or Malik (Deezer D). She is much less visible than the most notable nurse on the show, Julianna Margulies’ Carol Hathaway. She’s a minor figure. In The Atlantic’s ranking of the best ER characters, Lydia is number 32, and the accompanying blurb only points out mildly that Lydia “is the nurse who gets married early on in the show, back when the nurse characters talked more and had fun little background storylines.”

The depth of the nursing staff on ER was just one expression of the show’s defining approach, especially in the earlier seasons. ER is full — where House, Grey’s Anatomy, and The Good Doctor all take place in echoing clean spaces, often including empty sweeping staircases and massive glass walls, ER’s County General is a crowded, messy, lived-in space. There are signs and pieces of paper hung all over the walls. In one of my favorite shots from the pilot episode, Dr. Greene shimmies past a ladder set up in the hallway, where a maintenance worker is replacing a long fluorescent bulb that nearly misses hitting Greene over the head. No one mentions it, and Greene hardly even flinches. This is just what the ER is like; there are so many characters and so many stories happening in every imaginable corner of the facility that Greene trips over at least four of them walking down the hallway. Most of them we never see again, because they’re just one more piece of the inescapable background buzz. But the nurses are as much a part of the thrumming rhythm of the place as the doctors, and their bodies are a constant visible presence. They’re in the trauma rooms, they’re doing exams, they’re frantically calling for backup, they’re physically engaged in every case. Particularly in the earliest seasons of the show, you’re as likely to see one of the nurse characters filling a frame as you are one of the doctors.

It was radical for ER to make its show as much about the nurses as it was about the doctors. It destabilizes a fundamental idea about hospital hierarchy, the implicit sense that doctors who give orders are somehow more important, more valuable, and more worthy of attention than the nurses who execute them. Nurses were not just fun background figures on ER. One of the earliest personal dramas of the series is about Carol Hathaway’s suicide attempt, and Hathaway’s arc over the show’s first six seasons is arguably the most compelling and propulsive long-running story of the entire series. Carol often became the explicit representative of the show’s nurses-versus-doctors ideology; at one point she considers going to medical school, and in spite of her self-doubt the show makes clear that she would be wildly qualified. Carol decides against it. She is better, more useful, and happier where she is.

Nurses also helped ER underline one of its favorite early topics: the ins and outs of labor politics inside medicine. It’s something that drifted away in the later seasons as the show became more generic and its doctors became less human, but labor and relative ideas of worth are right up front in the show’s pilot, as egosticial surgeon Dr. Benton (Eriq La Sallle) complains that the nurses drank all the coffee in the breakroom. “We work 36 hours on, 18 off, which is 90 hours a week, 52 weeks a year. For that we are paid $23,739 before taxes,” Benton says. “We also have to make the coffee?” “My heart is breaking,” Carol replies drily, before walking away to handle the dozen other things she’s in the middle of doing. While the other doctors chuckle, Benton gets up to make the coffee. Later, Carol becomes the union representative for the nurses’ union, and eventually a manager, trying to balance salaries and schedules for the entire nursing staff. It was an ongoing story on ER, a recurring awareness that nurses were both indispensable and often underappreciated. And unlike the doctors, many of whom began as impoverished med students but gradually began cashing much more impressive paychecks, the nurses battled financial insecurity constantly.

ER refused to fall into the traps of treating nurses as mere side characters without personality, or as fonts of wisdom to be used by the doctors and then ignored. It also refused to ever flatten the nurse figure into any single character; there were always many nurses, almost all of them with names and quirks. (Chuny! Conni! Sam!) The constant nursing presence was one part of ER’s interest in making County General a full, hectic place, constantly gesturing toward the hundreds of other stories happening inside the hospital, even if viewers only ever saw them in quick glimpses. Nurses were more crucial than that, though, more than just background filler or important context for the doctors’ lives. ER always treated its nurses as people, with desires and tragedies totally separate from whatever was happening in the lives of the supposedly godlike residents. It was not just good storytelling. It was a radical way of rethinking who matters most in a hospital, and what stories are worth telling.

The Doctors Made ER Great. The Nurses Made It Radical.