'Royal Pains' ep. 3: Strategic Planning (but not very much, or very well)

Okay. So, the pilot was enough to get me interested (well, that and the marketing assault on Facebook and Twitter). Last week, there were glimmers of hope in terms of how Divya, the PA character, would be presented. In this, which appears to be the second episode written/ filmed but the third one shown, there were several 'facepalm' moments. Consider it one step back after last week's two steps forward, which means in other words that I agree with the decision to show these out of order. Bottom line: if this had been on last week, according to my lovely wife, she might not have been watching last night. I would have, because I'm an old man and I enjoy yelling at the TV.

A + denotes something I liked, and a - is so much more than just a bullet point-style dash.

In the opening bit, Hank is trying to get Evan to go for a nice cardiovascular system-exercising run, while Evan is trying to a) scope chicks and b) get Hank to admit their new enterprise should probably involve caring about money, just a little. While trying to make a questionable point about how dogs and women are somehow the same, Evan causes a dog-walker, who is otherwise minding his own damn business, to be bitten in the hand by one of his charges. Rather than stomp Evan into a coarse paste of hair gel and poor judgement, the kind-hearted dog walker (whom I want to call "Benny," and will since IMDB is no help today) apologizes. Hank, being Hank, looks at Benny with soulful eyes, says "I'm a doctor," and mumbles physical exam findings. Yup, that's a dog bite, all right. Pretty crappy exam, though.

+ Hank quite rightly says Benny needs to get to the ER for 'a thorough cleaning' instead of stitches. We don't sew puncture wounds.

+ It's good that Hank pokes holes in his water bottle and squirts the jets into the wound to clean it (a little, anyway). Research shows that the two main things that prevent infection are 1) using A LOT of irrigation, and 2) having a little pressure behind it. So just unscrewing the cap and dumping it would be, according to some research, less helpful.

- On the other hand, there were like 8 or 10 holes in that thing, which means the effect is lessened... and lots of the water was nowhere near the wound. And of course, whatever's left in Hank's 20-ounce bottle is of almost no help. Would have been easier to just hold the guy's hand under a drinking fountain or a simple garden hose for a good 10 minutes.

- And the number one question Hank would ask, as a real-life Emergency doctor: "When was your last tetanus shot?" THAT'S the reason he needs to go to the hospital.

After this B plot is safely sailing, some more silliness occurs. Further evidence that this is actually the second episode comes in the form of a conversation with Boris. Later there will be scenes between Hank and Jill that completely ignore what we saw last week in the 'real' episode 3, and a conversation between Hank and Divya that bears (scrawny, shriveled) fruit last week, which would have been 'next week.' Honestly, I'd have preferred they leave this one in the drawer, show us Episode 4 now, and call it good. But I'm getting ahead of myself.

Hank and Divya arrive on the scene of this week's "Privileged D-bags Who Are Actually Not That Bad Once We Understand Them Better." I'm going to call them PDB's, for short. On the way in, Hank gets Divya to confirm the info I previously had as a rumor, which was that she somehow went to two to three years of PA school, for 8 to 12 hours a day, without her family catching on. Oooo-kay.

I can't decide if this is a Screw the Midlevel moment, because Hank recognizes Divya's smarts and talent, saying she's "qualified to work at any of the major clinics in Manhattan." Instead, I think this is meant to be her big defining conflict for the first season. I'm already looking forward to the scene where Brian George appears as Divya's strict and demanding father, whose heart melts when he realizes what a strong and capable woman his little girl has become. And sort-of-almost a doctor, too!

And then we meet the PDBs. Momma-PDB is a driven, icy matriarch who is focused with such laser-like precision on her family's success that she neglected to develop a third dimension to her character. Her offscreen husband is a former Fed director and current US Senator, but not the President, and therefore is a total failure. Good Son PDB somehow bears his mom's pathologic orchestrations with good humor, perhaps by doing drugs or appearing in drag shows in the city every few weekends (either of which would be far more interesting than what actually happens). Daughter PDB is as high-strung as Mom, as bland as Good Son, but is blonde. This must be offscreen Dad's contribution. That, and a slow-burning irritation with The Way Things Have Always Been that will result in a totally unsurprising confrontation later.

Seriously, the first time she tries to object to something, Mom lays down the law, and closes with her wacky catchprase "...is that okay?" we already know about 75% of the dialogue for that inevitable scene. Which will of course have to happen today, and which will of course feature Hank standing nervously nearby, because he needs to, House-like, catch the one key phrase that randomly blows the whole case wide open.

Okay, here's the deal. I have advanced training in medicine, but I also have a degree in theatre. And I'm here to tell you, this writing sucks. It smacks of unused bits from the pilot and random scraps from pitch meetings past. For the rest of this week, I'm going to try to stick to the medicine, so as not to get too depressed here. Oh, I'll be watching next week, and I'm sure it will be better. Because it can't help but be.

+ I was amused at the medical equipment in the PDBs' former 'game room.' Hank and Divya might have a clue how to operate maybe half of that stuff. Mostly, the 'executive physical' line made me smile (since I've been to two of the Mayo facilities, and that's kind of how patients are encouraged to think sometimes), and idea of a yearly head-to-toe physical done as an action montage! was loopy fun (for me, because I'm weird).

- Why the eff does a healthy 18-year-old need a treadmill stress test, or even an EKG in the first place? Must be a college athlete thing, hey? And what, no hernia check? That's easy comedy gold right there! An echocardiogram is always a nice visual. And sweet zombie Jesus, where did Divya learn phlebotomy? That looked like a two-inch, 18-gauge needle attached to nothing in particular she was jabbing into the patient's AC.

+ Need to check your patient's vision, but don't have a Snellen chart? Yeah, there's an app for that.

+ Later on, after Good Son PDB gets really sick, really fast, for no good reason, they'll do a spinal tap. He'll be in fairly poor position, and they'll take out a whole lot of fluid, assuming the vials we don't see are as full as the one we do. But props must go to the writers who refer to there being four of them, and which tests to do on each.

- And, um, -SPOILER ALERT!- part of that executive physical would be looking in the ears the way they checked the eyes. AUTOMATIC FAIL for not seeing the deer tick suctioning off Good Son's football awesomeness drop by drop through his ear canal.

- Wait. It would have been a good idea to get him to a hospital earlier, but now he's too unstable to move? What did you do in there, Dr. Hank? And in the pilot, after you opened up Tucker's pericardium with common household materials, you remembered that the helicopter is a flying ICU. What, now that you're staying that's not good enough? Wow. You've changed, dude.

- Divya. Yo, Divya! Hey! Look, thanks for pre-oxygenating the patient before the intubation (holy crap, you did have the O2 hooked onto that thing, right?), but now that the tube is in, it would be helpful if you a) checked the end-tidal CO2 thing, b) listened to make sure the tube is in the trachea, or at least c) BAGGED A LITTLE MORE SLOWLY. We're not trying to get this guy overinflated or alkalemic. Air has to go in and come out. Where did you go to school, again?

But eventually, the offending parasite (literally, not any of the PDBs) will be removed, and everything will be cool. And this being the Hamptons, Hank has not actually just wasted tens of thousands of dollars on a workup that would be obviated by looking in the patient's ear, because the money was already wasted when Momma-PDB bought the equipment. So I guess that's a win, in terms of the larger health care system.

I'm not talking about the fastest-developing case of hot tub folliculitis ever, because Evan was an embarrassing 80s-movie cliche horndog this week, and I'm not sure if those girls were supposed to be over or under 21. Everything about that plot was creepy and weird. "Hey, girls! We're hanging out with a skinny loser we just met, but his house is nice! Let's do body shots... off, um, each other maybe? I guess? I really didn't think this through, but don't worry because USA Network wouldn't make us actually do it, so long as we say 'body shots' a couple times! Wooo!"

+ Grudging props are however given for the line "I tried all day to convince these girls I wasn't a douchebag, and they all went home smelling of vinegar and water." I have an uncomfortable feeling that the entire plot worked backward from this line, but what the hell. It was funny.

At the end, there's a heartwarming scene where Hank earns a gold star for the first part of this exchange:

Hank: So we should talk about your title...

Divya: What's wrong with 'Physician Assistant?'

Hank: Well, people tend to just hear the second part of that.

My heart swells, I get a little misty, and I hug a throw pillow to my chest. "Oh my god," I think, "the writers of Royal Pains really understand me. And they... they like me." Hank continues:

Hank: I was thinking more like, 'Associate.'

And, y'know, fair enough. There are plenty of people who would prefer 'Physician Associate' to 'Physician Assistant,' and indeed back in the very earliest days of the profession, the former term was actually the one that was used. And people really do trip over the 'assistant' part. It's true that no, we are not independent practitioners (and don't really want to be), but we are professionals. We practice medicine too, and our job really isn't following the doc around, fetching stuff, or answering phones. It's practicing some of the medicine, so the doc can concentrate on his or her own part of it.

But for better or worse, Divya's license says 'Physician Assistant,' and so does her Master's degree. She can be "Hank's associate in the practice" and a PA at the same time. It would be far better if she would stop saying she's "Hank's Physician Assistant" (even to the point of inserting a word into the phrase "Hank's assistant") because that's just as confusing.

But whatever. They just started working together. As time goes on, he'll understand how well-trained she is, and how good her skills are. She'll learn (mostly medical) stuff from Hank; he'll learn (mostly Hamptons survival skills) stuff from her. Eventually, Divya will show up for calls herself, and get Hank involved on those cases where she recognizes she needs the backup or additional expertise.

Maybe. If the show turns into a more interesting (and more realistic) direction. I still have hope, but wow, this was not the episode to show to people who want to check it out for the first time. This one was a C+ all the way. It might have been a B-, but having seen what they can do, I know they either weren't trying here, or else they were trying and failing to illustrate some point about Hank being out of his element, the team needing to learn to work together, or something. The acting was fine, but writers just failed to have a decent plan.