Multimedia: Emergency soaps
Authors: Ed Walker
Journal: BMJ (1999)

Casualty, BBC1, Saturdays ER, Channel 4, Wednesdays

  If there’s one thing we all want from television programmes these days, it is authenticity. With the advent of Jerry Springer, the revelation that award winning documentaries were faked, and the disclosure that even Vanessa Feltz (whose husband, in case you had missed it, is a gynaecologist) was duped by agency actors, it’s a confusing time.

We need more shows that don’t pretend to be something they are not. More shows that are so obviously theatre that no one in their right mind could possibly mistake them for real life. More shows like Casualty and ER. Many emergency specialists long to live in a city like Holby, where BBC1’s Casualty is set. It’s not a big place, but it has a railway station, an airport, a harbour, a motorway, all night rave venues, a flourishing drugs scene, and an endless supply of dangerous chemical factories. It is also surrounded by farmland, providing ample opportunity for ghastly agricultural accidents involving heavy machinery and severed limbs. It’s every trauma junkie’s fantasy town. 

This week, they had a bank robbery that went horribly wrong and, as a result, stretched over two episodes. It looks as if the department’s registrar is going to meet a sticky end, having been held hostage by the villains. (You can’t miss the villains; they’re the ones with the evil ski masks and carrying the bag marked “swag.”) Her loss will be a particularly heavy blow for Holby’s accident and emergency department, which has only three doctors to start with, one of whom, the consultant, is currently having an affair with a bottle of vodka. This was presumably why he was to be seen listening to a patient’s chest having forgotten to put the stethoscope earpieces in his ears. The senior house officer will be the only one left in the place in a couple of weeks, and he’s too busy smouldering to see any patients. 

It would be nice to think that a show watched by millions might have some effect on the way people behave as patients, but if there is an effect it’s a subtle one. No matter how loudly people tut-tut at the drunken, abusive, or malingering patients that regularly feature on the show, exactly the same number of them keep on turning up. Maybe they think the portrayals cannot possibly apply to them, or that telling the sister to piss off is the correct and proper response when not seen and treated within 30 seconds. Or maybe they just don’t watch it.

Casualty’s American cousin, ER (that’s “Emergency Room” to the uninitiated), has had one noticeable effect at Holby. Now, as soon as they get someone in the resuscitation room, the doctor barks out a whole list of commands—blood tests, x rays, IV fluids. The difference is that in ER someone does something about it; in Casualty everyone just carries on staring at the patient. ER is set in Chicago and makes the Holby department look like Disneyland without the drive-by shootings.

US emergency centres have achieved almost mythical status over here, with staff as well as patients. The image has been bolstered by the arrival of the advanced trauma life support (ATLS) course, which originated in the United States (the manual is full of references to roentgenograms, celiotomies, and diaphoresis). Having your ATLS certificate is de rigueur these days, and things are done very much “by the book” when it comes to trauma. US imperialism takes many forms. It is easy to imagine that every US hospital has a department like that featured in ER, staffed by George Clooney lookalikes, where lives seemingly lost can be saved, and everyone has perfect teeth. The reality is that there are just as many ugly, smelly doctors over there as over here and just as many silly, basic mistakes made every day.

Perhaps as a concession to the huge British appetite for the show, the producers recently included a token Brit on the cast. It might be just me, but the actress in question, Alex Kingston, seems strikingly reminiscent, in the nicest possible way, of the Queen or Princess Anne from certain angles—surely a complete coincidence and nothing at all to do with the other interpretation of “ER.”

The biggest mystery on the show is the inexplicable single crutch which Dr Kerry Weaver (attending ER physician) always uses to get around. A walking stick, maybe, but why a crutch? Although easy to poke fun at, it’s compulsive viewing for millions and is a fabulous show, mainly because the characters, despite the annoyance of their near perfection, are all likeable and very watchable.

Casualty, in its own British way, is also watchable telly and consistently tops the Saturday night ratings. There was talk last year of it going thrice weekly, but instead they have gone for a “first”—the first soap within a soap. Holby City revolves around life in the hospital where Casualty is set; like running Weatherfield Town alongside Coronation Street. The programme exploits every media cliche about medicine you’ve ever heard of, and a few you haven’t. It’s Eastenders meets 999 Lifesavers with a dash of Barrymore and then dumbed down.

At the end of the last episode, two lads broke into the ward pharmacy to steal drugs. These days, what really happens is that a small, valuable piece of medical equipment gets stolen and is sold on to buy a larger quantity of better quality drugs than you’ll ever find in any ward’s drug cupboard. A pretty nurse gave chase and cornered the two in a room full of sharp, pointed surgical instruments. You can probably predict what happened next. If you can’t you’ll probably really enjoy the show.