"Royal Pains" Ep. 2: There Will Be Food (and potential)

So, there's a new summer show on USA. It's on after the ridiculously enjoyable Burn Notice (which is itself kind of a mix of The Rockford Files and a Bourne movie), and worth checking out. But what's germane here is that Royal Pains features a PA character, the first on American prime-time TV since Jeannie Boulet on ER way back when.

Given the show's premise -- talented Emergency Med doctor's career goes boom when hospital beaurocrats throw him under the bus after a hospital trustee dies; he falls into being concierge doc to the spoiled rich in the Hamptons -- I was curious how a PA would fit in. The pilot showed us Divya Katdare, a sharp young woman from a wealthy family who apparently wanted her to be an MBA instead. This being New York, I'm assuming she's RPA-C (since they use both the R for 'registered' and the national standard '-C' for certified), but it's not like they're showing us close-ups of the characters' business cards.

Last night was only the second episode, so I have many questions, hopes, dreams, and fears when it comes to how this all might play out. It would be pretty sweet to have a PA as a major character on a popular hour-long drama. Likewise, considering all the annoying misperceptions there are about the career, this new show could wind up part of the problem. So I'm watching, carefully.

So much so, in fact, that I decided I'd take a page from Scott, MD over at Polite Dissent, and do a weekly write-up of the episodes, evaluating them for medical as well as narrative quality. He does it for House, and it's a great read every week, whether or not you are a medical person. Put a bookmark there, and check it out whenever you've just watched an episode and wonder "wait -- does it really work like that?" (The short answer is, probably not, but like I say, Scott's site is about enjoying the details.)

So I basically watched Episode Two in liveblog fashion: I fired up the DVR this morning, took some quick notes, and proceeded to pick things apart. There's good stuff too, so annoyances and errors are denoted with + or - for bullets.

* Hey, new pre-title voiceover to set up the plot. Wow, we really do love Burn Notice, don't we?

- Would it kill the producers to have Hank say "Emergency doctor" instead of "emergency-ROOM doctor?" Not that it's their job to correct every little misconception, but I don't see the benefit to perpetuating them. Whatever. Last week, he was not only EM trained but also did a fellowship in toxicology.

- Um, hey, you don't need an MD to examine a wound or take out sutures. Divya could totally handle that; but I see, having Hank present in that scene was important to the story, so that the crew could be invited to the party. I'm going to count these instances of "Screw the Midlevel" as we go on through the season. They could just as easily have had Hank walk up to Divya finishing the suture removal, with Tucker saying something like "naw, I just wanted to see if you felt like hanging out." This not only doesn't screw the midlevel, it fits the whole "Tucker needs a dad" thing.

- That wound looked okay, if a little too red at the medial aspect, but the sutures looked like crap. Apologies to the props person or set medic who gamely threw some stitches into a piece of moulage putty, but ya should have gotten some better reference photos. That looked like it was done by a Navy Seal under fire. On his own abdomen.

+ The actual title sequence, with trippy underwater stuff and backwards-cam, was pretty cool on first viewing. I wonder about all these cheap stethoscopes in the promo materials for the show, but maybe you'd have to pay 3M or something if everyone rocked a Littman like in real life.

+ Evan gets all the best lines. As a temporary Chicagoan, I laughed out loud at "ketchup is for dillettantes and three-year-olds." My wonderful, lovely wife puts it on everything, and I mock her for it.

+ "You need some blood work. I'd love to have my associate Divya do a full workup." Holy crap! They do understand what PAs do... unless they think she's a phlebotomist. But no, let's give the writers some credit here. Divya would, according to Hank, draw the blood, get the lab to do the appropriate tests, and then interpret the results. Which is true. But then, that makes instances of "Screw the Midlevel" that much more notable. Okay writers, you're officially having it both ways. (I'm doing that gesture where I point to my eyes with two fingers, then turn them around to point at you.)

- You do realize that 'I get blackout drunk on those rare occasions when I drink' is still kind of a red flag, right? I mean, nice plot device and all, but Hank is so concerned about everything, all the time...

+ Hey cool. Andrew McCarthy is Cary Grant as C.K. Dexter Haven from The Philadelphia Story. I love that movie! ...Oh, no, wait. He's an ass. And a very well-done "that guy is an ass" scene it is, too. Yowch.

+ I'm really enjoying not only Evan as a character, but what Paulo Costanzo is doing with it. The cooking/dancing went on a little too long, but it won me over. Although, how long did that food sit out if the ballerina wasn't coming over until after sundown? I also really liked when he admitted that NYC had gotten stale for him, which sheds some additional light on his drive to get Hank to the Hamptons last week.

+ The "Robin Hood of medicine" thing, as illustrated by Hank's speech on Bill's boat, is an appealing fantasy. Gosh, if only more of us could just draw fat checks from random rich people, and give our services away to the rest of our patients!

+ The running gag where Hank never, ever, gets to eat a bite of anything (until the end, sharing Chinese food with Jill) was cute. In the ER, nothing makes more work appear like ordering or heating food.

+ Hey, House writers: see how it works? A character who understands physiology sees a patient go into shock (shock being defined correctly as "perfusion insufficient to meet the metabolic needs of the patient"), looks at the heart monitor, and then identifies it as 'cardiogenic shock.' A little clunky and over-exposition-ey, because 1) who really cares at that point, and 2) duh, but still. Divya clearly knows medicine. This is nice, because as of now I trust the writers to know she's not a medical assistant, even when they treat her as one. (Caveat: I haven't seen this reaction to gluten, and I'm a little skeptical it would clear that quickly. Also a three-lead portable monitor isn't a Holter, and come to think of it I never saw them put pads on the patient, but since so much of medicine is boring we give some slack on these matters.)

- People, we never shock a flat-line. That TV trope has to go. Draw up the epinephrine or atropine, but put down the paddles and back away.

Overall, this was a nice solid A- of an episode. I'm feeling generous since while things are still very new, I'm seeing more to like as more is revealed about how the writers and producers approach the characters and the medicine. The show is finding its equilibrium between commenting on how "the system is broken," presenting its version of what's both cool and important about the practice of medicine, and keeping the story moving for its characters. My PA-touchstone character got zero development in this episode, but on the other hand she displayed some competence and knowledge. I'm feeling a Divya-centric B plot coming soon, if not a main story. Let's hope I'm proven right, and they do a good job.