Saturday, July 25, 2009

It's Not Them, It's Me

I am now two episodes of "Royal Pains" behind. I have yet to watch, much less write about, the sixth and seventh episodes aired. Whether this is significant, or how much so, I can't say yet. I am given to understand that Divya's storyline is featured a little more in the next few episodes, so when I get around to it I may be happy about the project.

Hey, professional TV critic Alan Sepinwall stopped watching or blogging about this show three weeks ago. You're totally getting what you pay for here.

I've been simultaneously busy and lazy, which isn't easy to do. I was out last night with some of the crew from my old ER job, and tonight I was seeing live thee-a-tah, with a friend tearing it up in several cool roles in Wilder's The Skin of Our Teeth. Which is anatomically just wrong, by the way.

After some more resting and recreating, I'll get back to this little project of mine. Soon enough that paperwork will go through and I'll have actual work to do.

Wednesday, July 22, 2009

Royal Pains Ep. 5: "No Man Is an Island": My reception is flagging a little, too

I've taken my sweet time writing up this episode, and indeed haven't watched episode 6 yet, for a few reasons. Most importantly, as mentioned in the previous post, I am temporarily living a life of indolence and sloth. A close second was that this episode didn't realy grab me. After the heady thrills of seeing the PA profession portrayed in a pretty damn positive and generally realistic light, here we have an episode with nearly no Divya. As much as Hank and Evan's core story was advanced a little, and despite a couple of nice moments from the actors, this episode felt, to me, solidly okay but by no means great. I'll run down what I can from my notes of a week ago...

Hey, that's some kind of record: this week's shameless product placement came approximately 0.8 seconds into the episode. Mmmm, doesn't that Gray Goose vodka look classy as it drifts across the screen on a silver tray? Smooth. And bills paid, we move on to some Hank/Jill flirting, which is about as white as humanly possible, seeing as it includes a job offer and talk of playing glockenspiel in marching band. I know this show is set in the Hamptons, but it really is embarrassingly Caucasian.

Anyway, Hank now gets to consider whether he'd rather stay the course in his new life of glamor and heroism, tending to the needs of PDBs who are, deep down, not all that bad, versus returning to the ED. To his credit, he politely tells Jill he'll think about it. Laughing in her face would probably kill the mood, anyhow. There follows an almost-sexy scene, cut short by Evan being almost funny. Already this episode is failing to grab me. Our wacky caper this week involves people who are stupidly rich, even by Hamptons standards. Okay, that's new. Sort of. The sooner this show resolves its schism about whether being wealthy is a) fascinating and exotic or b) just a characteristic that some families or people happen to possess, the sooner we'll be over the need to blather about nanotechnology being "so last year" and get on with the interesting bits.

A small dose of Divya helps, somewhat. On the tarmac of the local airport, she is competent, in control, and will be doing all the medical stuff on the mainland while Hank and Evan screw around with the PDBs of the week. It's the 21st century and I have digital cable; can't I just stick with her story for the entire time period of the episode? Evan by the way has had his obsequiousness ramped up to eleventy-five by the writers this week. It's possible they are trying to humanize the PDBs by placing them next to a super-douchey version of Evan in their first few onscreen minutes. Divya drives off, taking my enthusiasm with her.

Sigh. So the PDBs are a family made wealthy by technology, who get away once a year to their island. The two sisters have fond memories of roughing it in a little 2000-square foot cabin, with electricity, running water, a gourmet kitchen... you know, the bare essentials. The high-strung mom's kids carry more gadgets than most IT managers (shout-out to Nintendo DSi, surely another sponsor), and even the granola mom's tech-scion husband is lost without his Blackberry. Oh, and she's approximately 1000 weeks pregnant*. Subtle, right?

For some reason, they take a helicopter, rather than a boat, because while they need to carry a lot of stuff and will be utterly cut off if -- for SOME REASON -- something should happen to their one satellite phone, it's important to the experience that they also be totally reliant on the outside world. This is certainly less of a plot hole than the tick-in-the-ear thing from a few episodes back, but one line of dialogue would have made this a lot less dumb.

Fast-forwarding, there's some decent-enough medicine in Hank's well-mom check. Fundal height, blah blah, rare blood group, etc etc. Wait -- RARE BLOOD GROUP? Ruh-roh! I wonder if that will be important later?

Evan's presence is partly redeemed by a plot wherein he bonds with the young son, who appears to be useless and irritating in much the same way as Evan. Although in the end he will be the hero, he first has to indirectly cause a totally gnarly leg injury in the kindly caretaker of the island. Hank whips out his acid-washed jean jacket and goes into MacGuyver mode, practicing Wilderness Medicine. I'm not sure what's up with the antacid, other than it should in theory be sterile water. Sugar isn't a bad topical antibiotic for the situation, though I wonder about vodka.

Also, we tend to call them "open fractures," not "compound." Hank was doing that talking-aloud thing again, and apparently he was talking to a group of Boy Scouts.

Meanwhile, on the mainland, there are wacky misunderstandings. Divya is holding down the fort, and just when we're wondering why she needs Hank at all, she and Jill have a heart-to-heart. Divya is kind enough to delete Jill's horny, confused, generally 15-year-old-sounding voice mail, and Jill learns that Divya has tried and failed to start up a concierge practice twice before. Hank's arrival just happens to have served a pre-existing plan of some long standing. Hunh. Eeeenteresting.

Later, we learn that Jill's ex was an ER doc (an EM doc, if we want to be stick-up-the-bum about it). Hmm. Maybe she's into guys who work weird hours. Meantime, Hank is demonstrating a basically accurate Direct Coombs Test, if the test didn't require a reagent and you didn't need to wash the cells. For TV medicine, it's complex enough to demonstrate the basic idea: the family trait means matches are rare. Having a ten-year-old test himself is a little funky, but there's no time to think about that. The loser kid is the hero of the day.

And if Hank has IV tubing for some reason, how come he doesn't have antibiotics or wound care supplies?

There are some good Evan scenes near the end, together with little glimpses into the Lawson boys' formative years, so the actor wins me back despite a growing sense that the character could go utterly clown-shaped any moment. There's another nice scene where Hank calls the kindly caretaker out on sharing this weird blood trait with the family -- eighth-grade life sciences teachers across the cable-viewing nation may want to take notice. In the end, naturally Hank wants to stay Dr. Robin Hood.

So. A perfectly nice episode, and true to the central theme of the series, but now that some of the novelty is wearing off, I have some misgivings about how well or how long things can maintain. Not to mention, the paucity of Divya took some of the shine off this sunny summer series for me. Call it a B- this week.

* By which, I mean of course that 36 is closer to 1000 than it is to 100,000.

Tuesday, July 21, 2009

Awwww. Thanks!

Had a very interesting comment the other day. Apparently at least one person in the world thinks I need to talk about myself more.

Not to worry. I'm concentrating on this TV show at the moment because it's kind of a cool opportunity to talk about my career - the one that's just getting going for real, now, after a long and intense period of preparation - in a pop-culture-related way. And I have always been about the pop culture, even in the midst of my transformative journey.

So I will say more about, for instance, moving back to the Twin Cities, and what I'm up to as I get to actually spend time with friends and family. I'll get into what it's like to actually be doing what I've been working toward all this time. But for the moment, I'm kind of in Limbo. I can't start my new job until the state registration paperwork goes through, which gives me time to sit around the house and do nothing. After revving the engine pretty hard for the past four years or so (if you count Post-Bacc time, which I do), it was jarring at first to not have a deadline or an itinerary. I have since gotten over that, and am enjoying being really lazy. I can't even keep up with a weekly show that took a week off for a holiday, but I'm steadfastly refusing to worry too much about it.

This is a change, true, but I don't think it's a permanent one. Much, much earlier posts were about coming to terms with a huge undertaking. Then there were the ones describing what went through my head as I realized I was actually on the road. Now, I've arrived at the other end of that process, and like someone who has just driven cross-country without significant stops, I kind of want to sleep for three days. Maybe open the mail, make some toast. You know, nothing too challenging.

But the message is very appreciated. And I'll get back to my usual navel-gazing in due course. I promise.

Wednesday, July 15, 2009

Royal Pains Ep 5 niblet

This week, things keep chugging along for HankMed. We got some very MacGuyver medicine, a new batch of PDBs who are deep down very cool people, and one sexually-frustrated hospital administrator.

Not a lot that adds to the cause of PA awareness, but some nice Divya moments regardless.

A much longer review to follow.

Wednesday, July 08, 2009

Royal Pains, ep. 4: "TB or not TB" (but definitely PA-C)

It's been a big week in the Febrifuge household. Of several new developments, perhaps the biggest was that the household moved 400-odd miles. So, in terms of my own convenience, USA picked a great week to hold off on airing new episodes of Royal Pains. It took me a while to get to it, but I was rewarded with an overall good episode, featuring several refreshing bursts of Divya being awesome. It actually appears to be an intentional story arc that the PA is established as more than "doctor's little helper." Also, I got a job, and as recently noted, I passed my board exam and earned certification not long before that... so it's a good week to be me.

But enough yappin'. On to the show. As always, I'll try to concentrate on the medical stuff, with what I'm sure will be mixed results. Bullet points are for organization, but + means [yay!] and - means [meh.]

* Is it just because I'm watching on Hulu this week, or is the funky underwater title sequence really gone? That was cool, dang it. Okay, we're in a kitchen, people are busy, this one lady is really intense... oh, I see, somebody here is going to be the patient of the week. The head chef is too obvious, so I bet it's the tall skinny guy.

Oh, wait. This only looks, sounds, and feels like House. My mistake. It's Alison, the restaurant owner, who has weird neuro symptoms. She hallucinates that the high-end Italian food in her restaurant is something that Chef Boyardee made yesterday... or no, that's just what it looked like. Looks like there's a prop master out there whose employers need to pay for a few good restaurant meals. For research, y'know? Honestly, the blurry effect really was low-rent House stylings. Better-done, I would have called it an homage.

Medically, they had her experiencing blurred vision, and using the word "pizza" when she meant to say "pasta," then not realizing she'd done it. Actual word salad tends to be much weirder. My good friend M. Giant has had attacks where the language center of his brain crapped out on him as it's suggested Alison's has here. Since he's a writer, you can check out his description, for a more appropriate level of oddity and fear. In an otherwise healthy, young person, these symptoms are very scary indeed.

Since this isn't actually House, Alison's spell resolves, and rather than the sound of Massive Attack, there's another scene or two. The HankMed crew come in to administer PPDs to the restaurant staff.

+ Here, we have some impressively accurate medical procedure. Hank and Divya are both using the correct, 0.5ml syringes, placing little blebs of the solution right into the skin on the forearm, and telling people what the test is, and how it works.

- This week, the one conveniently overlooked part of the process that would obviate an entire plotline is not asking the patients about previous exposure to TB, previous positive tests, or previous immunizations. Especially given that more than a couple of the people working in this particular restaurant are from the old country, where the BCG vaccine is used, you'd think that would have come up. Huh.

+ Later, Hank is speaking privately to Alison about her freaky symptoms, and does some excellent doctoring in the way he counsels her. Sometimes advocating for the patient's best interests means getting in their face a little. And anyway, Hank's such a nice guy (I am 1/16th culturally empowered to call him what he is, a mensch) that he barely seems to be harping on Alison. Honestly, I'm ready to see the character turn the frustration up a notch, and be a little less perfect.

+ No wait, the title sequence is here after all. The show is just messing around with the best place to put it, and seems to be studiously avoiding the most House-ian possible placement, immediately after the 'tease' in which someone gets ill. (And thanks to the CG guy who was nice enough to post a comment saying he'd created it. Yes indeedy, the use of clozapine, an anti-psychotic, on the label was cute. There is no version that comes with APAP - which is acetaminphen, or Tylenol - but I agree that the guy who added that was on to something. I'm all for creative license.)

+ Just after we're back from commercial, Divya delivers a lecture to Evan that is music to my ears. After Evan makes the fatal mistake of calling her "doctor's little helper," she unloads on him with a combination of the "What is a PA?" text off the AAPA website, and a beguiling mix of excellent diction and attitude. "I am a certified Physician Assistant," she says, much the same way one might say "I am going to stomp your smirky face into chunky salsa." I stop to wonder if because she's in New York, she might not want to say "Registered Physician Assistant," instead of the "certified" that is standard everywhere else in the US, but give up the thought as she rolls on.

"That means I practice medicine. I prescribe medications. I order and interpret tests. I assist in surgery..." And then Hank strolls up, having figured out he can't be there in three days to collect results on all those tests, so asks her to do it solo. He delegates that part of the practice to her, having her do it independently, conferring his legal and clinical authority to her.

+ And I pretty much faint, because that's exactly right. That's what it is, that's how it's done. I've been worrying about how the PA will be portrayed in this show, and whining about the "Screw the Midlevel" moments I saw in the first episode or two, and here the show is saying almost exactly what I would tell them they should. And since this is only episode 4, surely this scene must have been written - and filmed - before the pilot aired. So, nice work, show. I feel much better about this whole Divya the PA thing.

- Later, there's a level of product placement that is impressively tricky: advertising two different car brands at once. I applaud at the TV, sarcastic clap style.

+ Paulo Costanzo continues to walk away with all the Evan/Hank scenes, despite an alarming trend toward overly broad, buffoonish moments. Driving a golf cart across town? Ehhh. Maybe not. But Costanzo's tirade against brunch, and especially his delivery of the phrase "french toast salad," are comedy gold.

+ I was impressed by the way that for once, a TV doctor's blunt declaration "she's had a stroke" made some kind of sense. Given that Hank had spoken to Alison previously, and being a kick-ass doctor, it made sense that he could be so sure in his diagnosis so quickly. This was refreshing.

Hey wow, what a concise and timely explanation of thrombolytic therapy. Dr. Exposition, please report to Act Three. Doctor Exposition, Act Three. And I suppose it's cool to show that Hank doesn't get to go wherever he wants inside the hospital, even if he is dating the administrator.

Someone who works in NY state tell me if the short white coat is really what MDs wear in the hospital. I saw the 40-something guy rocking the short lab coat and thought, "huh. Another non-traditional student." And I still say people look like steakhouse waiters in those damn things.

Um... why does Boris need a tiger shark? Who is Katie, and why does she need to be called right away now that he has one? And holy crap, tonic immobility is a real thing, although no way does it last 20 hours. Looks like I must have missed a couple of Shark Weeks.

(Total and utter tangent: this week I also saw an amusing signature line on one of the medical forums I visit: "Live every week as if it were Shark Week." Inspirational, isn't it?)

Wow, they must be rich in the Hamptons, because Dr. Short-Coat responds to Hank's request "Can you get me some thrombolytics" with "sure." Not with "don't you mean tPA, Dr. Slick?" and not with "you mean the package that has to be back in the fridge in half an hour if it's not used, and costs like three thousand dollars if you so much as peel back the foil?" nor with "you don't have privileges here, and can't walk past the yellow line, and I'm going to hand over super-expensive drugs? You want a fistful of Perocet too, you delusional weirdo?"

But then again, not having the magic meds (which looked amazingly like a 10ml saline flush, and apparently didn't require mixing or prep of any kind) would have robbed us, the viewers, of another MacGuyver medicine moment. The DIY Bair Hugger (which in the medical world is essentially what they made: a blanket made of hollow baffles, through which warmed air is pumped) was pretty cool, I'll grant them that. And presumably Divya established two really fast IV lines, with that pimped out SUV kit of hers.

Speaking of which, Mac-compatible, portable Xray? Damn. Notice too how the readout had Hank's name on it; the PA-MD team very often puts the MDs name on stuff like that. The team's medical decisions are ultimately the MDs responsibilities, but the PA has as much latitude and independence as the MD wants to grant, so presumably the practice agreement says that Hank is totally comfortable with Divya's ability to read a chest x-ray. Maybe she'll ask him to check it out later, as a quality measure, but when she says "it looks good," that's the same as Hank saying it.

The episode winds up with what I take to be a future plot point: who was Jill formerly married to? My money's on Boris, actually. If not him, then a new character, played by Ted McGinley.

Overall, I have become very impressed with some of what's coming out of the writer's room on this show. Not having viewership numbers handy, I can't say for sure but they have done more for the public's understanding of the PA profession than our actual professional association has, in my opinion. If only they would add a layer of quality control to the plotting, and stop letting conflicts arise via series of events that would be rendered moot by the same common sense the characters show except when the plot demands they be dumb. That's the kind of story-craft that makes Three's Company plots work.

A- for the episode as a whole. Some good doctoring from Hank, some silliness over poor Italian translation and a critical question never asked in any language, tempered by Divya-liciousness. The minus is for Divya knowing the BCG produces false-positives, but only knowing it in Act Five.

A+ however for what's going on with Divya's character progression. If I find out the AAPA is connected to the bracingly clear way this show presents what a PA is and does, I'll take back most of the things I've said about them.

Thursday, July 02, 2009

A week off

Looks like the nice people at USA are skipping an episode of Royal Pains for the holiday weekend. This is nice for me, as I just moved 400 miles, and I'm taking off for the holiday to a place where there are no Internets.

So watch next week for my write-up of the fourth episode broadcast.