Notebooks Esteve Foundation 42

notebooks Esteve Foundation 42

Television fiction viewed from the perspective Medicine in Television Series of medical professionals

House and Medical Diagnosis. Lisa Sanders Editor: Toni de la Torre The Knick and Surgical Techniques. Leire Losa

The Sopranos and Psychoanalysis. Oriol Estrada Rangil

The Big Bang Theory and Asperger’s Syndrome. Ramon Cererols

Breaking Bad and Methamphetamine Addiction. Patricia Robledo

Mad Men and Tobacco Addiction. Joan R. Villalbí

The Walking Dead and Epidemics in the Collective Imagination. Josep M. Comelles and Enrique Perdiguero Gil

Angels in America, The Normal Heart and Positius: HIV and AIDS in Television Series. Aina Clotet and Marc Clotet, under the supervision of Bonaventura Clotet

Nip/Tuck, Grey’s Anatomy and Plastic Surgery. María del Mar Vaquero Pérez

Masters of Sex and Sexology. Helena Boadas

CSI and Forensic Medicine. Adriana Farré, Marta Torrens, Josep-Eladi Baños and Magí Farré

Homeland and the Emotional Sphere. Liana Vehil and Luis Lalucat Series Medicine in Television

Olive Kitteridge and Depression. Oriol Estrada Rangil

True Detective and the Attraction of Evil. Luis Lalucat and Liana Vehil

Polseres vermelles and Cancer. Pere Gascón i Vilaplana

ISBN: 978-84-945061-9-2 9 788494 506192 42 Notebooks of the Esteve Foundation Nº 42

Nip/Tuck, Grey’s Anatomy and Plastic Surgery

María del Mar Vaquero Pérez

Both productions could be considered to be the launching pad for two meteoric careers: producers Ryan Murphy and Shonda Rhimes. Today they are two television industry heavyweights. The former sprang to fame in 2003 with Nip/Tuck, a polemical vision of plastic surgery, shown through the lives of its two con- troversial protagonists. Along with The Shield, this program brought the cable channel FX into the orbit of series addicts. Years later, he would again work for this channel on American Horror Story. Shonda Rhimes’s career took off in 2005 with Grey’s Anatomy, which still keeps audiences in their millions glued to the screens of free-to-air channel ABC. Its success has enabled the channel to open a production company for TV series (Scandal, How to Get Away with Murder), now dubbed Shondaland.

It might seem obvious to begin this chapter profession, meaning they share the suffering and dedicated to plastic surgery in TV series by men- recovery of the sick. There are stories of interpret- tioning the fascination that doctors’ private and ing the patient’s death as a personal failure, or as professional lives have always held for viewers. proof of the uselessness or insufficiency of their Every aspect relating to medicine, to the work knowledge. And even –why not?– stories of the and coexistence of health professionals in that doctor who acquires more of a human dimen- independent city that a large hospital constitutes sion when he or she switches roles and becomes are fertile content. Such aspects include the dra- a patient. This is a fascinating viewpoint, which matic change of lifestyle a disease’s appearance portrays how difficult it is to take (as the saying brings about, but also the analysis of symptoms, goes) one’s own medicine. like clues in a mystery movie, that lead to uncov- Medicine in film has given us marvelous stor­ ering the diagnosis of an illness. Witnessing the ies in every imaginable genre and setting. We progressive deterioration of a character suffering have seen doctors starring in romantic mov- from a degenerative disease, or –let us say it– the ies and who, prompted by love, seek a cure for moment of death itself, all of these are excellent their loved one. Or else they end up falling in love storylines for thousands of scripts. They contain with the patient they cure. In war movies of any enough elements of tragedy, drama, anecdote period, doctors often battle with few resources and human overcoming of challenges to attract but enormous inventiveness. In natural disasters viewers. or epidemics, they lead the survivors toward a The permanent contact of doctors with life, new dawn. In crime films, they reveal the best suffering and death make them the ideal heroes of a little-known specialization such as forensic in many stories. These include both their own medicine. There are innumerable stories more. It and those resulting from their professional voca- is tricky to find a medical specialization that has tion, which sometimes leads them to sacrifice not been dealt with on the silver screen. personal or family life. Similar are the stories of As if this were not enough, as series devel- their involvement with family members and pa- oped, TV let viewers get to know the doctor tients, stories of the empathy inherent in their starring in a storyline, and to share his or her de-

-75- Nip/Tuck, Grey’s Anatomy and Plastic Surgery

velopment and dénouement. Furthermore, view- understands what a plastic surgeon may do in ers could partake of the professional’s daily life his practice, he focuses on his facet as a creator in each episode, experience the adventures that or recoverer of beauty as the sole thing that holds so attracted them one after another. With every interest in fiction? Or is it that plastic surgeons weekly broadcast of her or his work, they shared ourselves have not known, been able or wished his or her achievements, failures and affections, to demystify that image that portrays us as the against a backdrop of recovery, loss, overcom- most enviable of stars? ing odds, frustration, life, and even death. Medi- The answer is surely a combination of all of cal television series have encouraged more than this. Though there are few, if barely any, posi- a few professional vocations, increasing student tive examples we can point to of this special- numbers in medical faculties, attracted by the ization on-screen, we will at least aim to reflect daily adventure of this profession. real knowledge of the specialization and try, by I think this reminder is apt so as to be aware demystifying the stereotype, to reveal the true of the scant treatment of equal depth and con- importance of what plastic surgery and its practi- tent the specialization to which we dedicate this tioners offer patients and the other medical spe- chapter –plastic, reconstructive and aesthetic cializations. surgery– has received in film and TV. I know some people would say that this is not so. We A little etymology and history are used to seeing stars undergo changes in ap- pearance. It could be so an actor can replace a Plastic, reconstructive and aesthetic surgery. This colleague in a long-running series without altering is a long name for a broad medical specializa- the storyline or the central characters in the plot. tion which is nevertheless most often abbrevi- Or maybe the character has a serious accident, ated to plastic surgery. It is, furthermore, wrongly or survives an assassination attempt that disfig- associated with just half of its content: aesthetic ures him or her, and must return with a fresh face surgery. This would be understandable in the to take revenge. These are recurring themes on- context of the broader public. However, it is un- screen. This is undeniably true, and is no doubt fortunately also the case among many medical the first notion that pops into our mind regarding professionals, who remain ignorant of everything plastic surgery. Yet outside of this easy script re- this specialization encompasses and the services source –a rather surreal concept reflecting none it can offer. Let us look more closely at them. of the reality of the specialization– what does the Plastic, reconstructive and aesthetic surgery broader public know about what plastic surgery is the medical and surgical specialization con- consists of when given its full name: plastic, re- cerned with correcting any congenital, acquired, constructive and aesthetic surgery? How has tumorous, or simply regressive process requiring TV fiction portrayed this specialization in series repair or repositioning, or which affects bodily on medical themes? Have the fictional charac- form or function. Its techniques are based on ters approached the plastic surgeon’s image as transplanting and mobilizing tissues using grafts a doctor with the same dimension as a health and flaps, or even implanting inert material. In its professional as has been fomented for other spe- most recent advances, it also employs complete cialists? units of donor tissue, such as limbs (arms, hands, Frequently, plastic surgery and its professional legs) and the covering of the face. practitioners only inspire frivolous plotlines or em- The full content of plastic surgery encompass- body characters lacking the basic ethical prin- es two fields of action. The first is reparative or ciples that govern the doctor-patient relationship. reconstructive plastic surgery. It seeks to restore Is this the fault of scriptwriters who are ignorant of or improve the function and physical appearance the specialization’s content or the fields of inter- of injuries caused by accidents and burns, in skin est it comprises? Or is it a deviation from reality diseases and tumors, along with the tissues be- that means that, though the scriptwriter perfectly neath the skin. It may correct congenital anoma-

-76- Notebooks of the Esteve Foundation Nº 42

Medicine in Television Series

lies, mainly facial, or on the hands or genitals, or scribed to reconstruct the nose, which is known else anatomical defects caused after an onco- as an Indian flap. logical surgical resection. Then there is aesthetic Yet no doubt it was World War One (1914– or cosmetic plastic surgery, which treats gener- 1919) which caused plastic surgery to develop ally healthy and emotionally stable patients. Such as a specialization. A huge number of soldiers surgery makes alterations that, while not con- were wounded by shelling and burns, as a result stituting pathological processes in themselves, of which their bodies and faces were disfigured. cause a deterioration of health to the extent they So professionals had to be trained and medical interfere with people’s physical and psychological centers specialized in surgical reconstruction wellbeing. So its aim is to correct differences from created, both in Europe and the US, where this aesthetic standards or the effects of ageing. specialization was not recognized. It remained A plastic surgeon, to use his or her shortened more or less associated with maxillofacial surgery title, may be concerned with repairing congenital for many years. Then in the Second World War malformations, treating and operating on burn (1939–1945), plastic surgery’s field of activity was victims, reconstructing any anatomical defect, expanded and it began to appear as an indepen- carrying out surgery by hand, conducting micro- dent specialization. Dr. Archibald McIndoe devel- surgery, re-implanting or transplanting limbs or oped (what for the period were seen as strange) faces, and performing aesthetic surgery. From transfers of healthy tissue to damaged areas, head to toe. In the words of Dr. Raymond Vilain, using pedicle flaps. These enabled many avia- the plastic surgeon is, in fact, “the last general tors who had been disfigured by fire to abandon surgeon”. the isolation to which they had been condemned Concerning the name’s etymology, “plastic” as monsters. Medicine had certainly saved their stems from the Greek plastikos, which means lives, but at the cost of depriving them of employ- to mold or transform. So in its entirety, plastic ment or social life in the community, and leading surgery is aimed at aesthetically designing bod- in the worst cases to suicide. So McIndoe’s in- ies through remodeling to improve them, what- novation thus lessened their suffering, reincorpo- ever the reason for surgery, or to make them rating them into acceptable social and aesthetic more beautiful. The plastic surgeon acts thus. norms. She or he seeks harmony, beauty and adapta- The Spanish TV series Canal Historia and tion to aesthetic norms and functionality. This is Odisea offer episodes on Dr. McIndoe, using pe- independent of that separation into two activity riod photos and the real voices of the veteran fields, which is demarcated, in fact, by society protagonists themselves to tell the stories of the and health systems (public healthcare and private young pilots in the Allied air forces he treated. insurance companies), which thereby attempt to When their bombers, loaded with large amounts limit the coverage of care intervention costs. of highly inflammable fuel crashed, the aircrew It is not just etymology that unites the func- were consumed in huge blazes, from which they tions of plastic surgery but also its documented occasionally managed to escape alive, though history. Both the Edwin Smith Papyrus from with faces and bodies totally charred. Survival Egypt (3000–2500 BCE, according to Breasted’s was a goal, but afterwards, tortured by their ap- studies) and the Sushruta Samhita (“Suśruta’s pearance, they needed their faces and hands to Compendium”) from India (500 BCE) document appear and function more or less normally again. nose reconstruction. In that period the nose and They wanted to feel like accepted members of that ears were considered to be appendages convey- society which, while respecting them as heroes, ing reputation and respect. So it was common to shied away from their disfiguration. Many were amputate them as a punishment against crimi- between 17 and 21 years old. Thanks to Dr. nals and defeated peoples. Rewards were even McIndoe’s innovative techniques of the time, paid for every nose and ear delivered. Even now- these men tell how the correction of their dis- adays we still use the frontal flap Sushruta de- figuring became a virtue. McIndoe founded

-77- Nip/Tuck, Grey’s Anatomy and Plastic Surgery

his Plastic and Maxillofacial Surgery Service at facets of medical practice. These are developed Queen Victoria Hospital in the village of East in contrasting environments, for likewise dissimi- Grinstead, Sussex, England. Here, people got lar purposes. They are even undertaken by sepa- used to seeing and accepting his patients on the rate medical professionals. street, in local pubs, and even in London itself. They would carry their pedicles like small trunks TV fiction and plastic surgery that transferred tissue from their abdomen to the arm, from there to the shoulder and then to To move on from plastic surgery’s noble and his- the face, finally becoming a new nose, cheeks torical facets to analyze its evolution in TV series or chin. During the time this process lasted, the involves a search. However, we find little mate- patients and those around them saw how these rial worthy of mention, because as far as I can disfigured faces were gradually conforming to a recall and trace, few TV series, whether on medi- normalcy accepted by all. cal themes or not, include a character having The patients who lived there, sometimes for this specialization. Perhaps the most famous in three to four years, and underwent 20–30 opera- recent years are doctors Sean McNamara and tions, managed to save not just their lives but also Christian Troy in the series Nip/Tuck, and doc- their minds thanks to plastic surgery and Dr. Mc- tors Mark Sloan and Jackson Avery in the series Indoe’s approach and psychological work. Sev- Grey’s Anatomy. We would like briefly to pres- eral ended up marrying the nurses who cared for ent these series to those viewers who have not them. They even formed a club, The Guinea Pig watched them, or who have heard of them at Club, which over its more-than 60 years of his- some point but do not know them well. tory brought together over 650 members. Years Nip/Tuck was a series that aired from July later, its survivors and their descendants continue 2003 to March 2010 on the American cable TV to meet to honor their “creator” and raise a few network FX Networks. It ran for six seasons and is pints to him while singing the anthem they com- considered an innovative TV product for its time, posed in his name. The light-hearted lyrics go: because of the subject it tackles and because “We are McIndoe’s army, it gave the language of TV series a filmic style. We are his Guinea Pigs. Classified as a drama series, it won the Golden With dermatomes and pedicles, Globe for best in its category in 2005. Already, Glass eyes, false teeth and wigs. in 2004 it had won an Emmy from the US Na- And when we get our discharge, tional Academy of Television Arts and Sciences We’ll shout with all our might: (NATAS), for Outstanding Prosthetic Makeup for Per ardua ad astra [“Through adversity to the a Series. stars”] The storyline follows the life and work of two We’d rather drink than fight…” plastic surgeons, Dr. Sean McNamara, played Knowing all this inevitably leads one to reflect. by the actor Dylan Walsh, and Dr. Christian Troy, It is odd that both the early plastic reconstruc- played by Julian McMahon, who run a private tions described in written historical documen- clinic first in Miami before moving to Los Angeles tation, and the main milestones leading to the to set up their practice in Hollywood. creation and development of plastic surgery as In the series, these professionals’ qualifica- a specialization, linked the components of ma- tions and practice is in fact merely an excuse terial, functional and aesthetic reconstruction so to explore one of the most polemic subjects on intimately as a basis for a person’s social accep- American television through the self-destructive tance and reincorporation into society. Yet nowa- nature of its characters, true both of the starring days, it is customary to observe how society has doctors and their patients. Furthermore, it dealt generally separated the aesthetic and recon- with topics that were not habitual on the medium structive elements into two clearly differentiated or in the US, such as drugs, abortion, homosex­

-78- Notebooks of the Esteve Foundation Nº 42

Medicine in Television Series

uality, transexuality, sects, personal ambition and were operating, talked about their personal lives, the constant search for pleasure and money. It relationships, families and hobbies, even their portrayed a lack of personal or medical ethics, money worries –all the while opening up and cut- and depicted lives dominated by envy, stress, ting into their patients’ bodies. lust and even crime. All of this doubtless earned it So these two TV series, with quite different significant criticisms from more conservative sec- takes on medicine and doctors, were both hugely tors, both in the US and other countries where it successful and on air for a long time. By focusing aired. on characters who are plastic surgeons, we will Grey’s Anatomy is a medical series from the elucidate how they portray this discipline in TV US network ABC, which began in March 2005 series. Does the educational tone and appeal for and is still on air. It takes its name from the re- the wider public, which every TV show strives for, nowned treatise on human anatomy, Henry manage to convey a faithful or at least realistic im- Gray’s Anatomy of the Human Body, better age of plastic, reconstructive and aesthetic sur- known as Gray’s Anatomy, a basic textbook for gery? Do they portray the lives and professional training US medical students published in 1958 dedication of these specialist practitioners? by Henry Gray. So it plays on his name and Dr. Meredith Grey’s, the series’ central character. The plastic surgeon: hero or villain? It won a Golden Globe for Best TV Drama Series in 2006 and has garnered a total of 38 nomina- In its time, Nip/Tuck was startling for its care- tions for the Emmy Awards in different catego- ful aesthetic, apparent right from the slickly ries (script, actors, direction, etc.), of which it has designed opening credits accompanied by its won four further awards. theme song, Engine Room’s A Perfect Lie. Since The series is set in Seattle Grace-Mercy West the credits and theme song are brief, we are Hospital, tracing the professional development of plunged into the atmosphere in which the story different medical specialists whose lives cross the will develop: aesthetic surgery. The discipline, protagonist’s. The series viewpoint is interesting by cuts and stitches, can recreate those perfect because it focuses on the life and hopes of the bodies –represented­ in the credits as cold, iden- resident medical interns who join the hospital to tical, beautiful but static mannequins without life train as future specialists. There is tough compe- or personality, and still semi-packaged– while the tition between them, but also passion not only lyrics croon: for medicine as a profession but for the value of “Make me beautiful, patients’ lives. A perfect soul, For the subject concerning us, we look at two A perfect mind, characters who, while they began as guest stars A perfect face, (conceived as occasional appearances in specific A perfect lie.” episodes), gradually gained prominence and be- came part of the core storyline, essential for the At first, it seems viewers are being offered the series’ development. They are Dr. Mark Sloan, same view as ever –beauty as little more than played by Eric Dane, and Dr. Jackson Avery, an end. Yet patience will reveal more. Its central played by Jesse Williams. characters are two plastic surgeons specializing Series creator Shonda Rhimes seems to have in aesthetic surgery who have been friends since conceived a fiction that offers a voice to intelligent youth. As we mentioned in the introduction, “aes- women who compete with each other. To do so thetic” and “reconstructive” are two medically in- she devised a medical setting based on the im- separable facets. Aesthetic, like reconstructive pression she got when over a period she became surgery, rebuilds bodies and fortifies minds. From obsessed, along with her sisters, with watching this viewpoint, the series seems to promise to surgical operations on the Discovery Channel. center on one of the few branches of medicine She was surprised that the surgeons, while they excluded from any health policy, since it covers

-79- Nip/Tuck, Grey’s Anatomy and Plastic Surgery

content that is not considered vital. It would even patients want to do with their bodies. Even if seem a good idea to publicize aesthetic surgery Dr. Frederik McLorg defined the specialization as as something that is not limited to artists or mil- “a surgical discipline that resolves problems”, we lionaires. It would be beneficial for viewers to also said that aesthetic surgery treats healthy and know what can be done for patients to feel good emotionally stable patients. But the truth is, none about themselves and in their surroundings, to of those on Nip/Tuck seems to be so. Added to overturn myths and, somehow democratize ac- this, with every episode, the personal storylines cess to the specialization. of the main characters get increasingly tangled. The program starts in the consulting room of When the whirlwind of their lives careers into a doctors McNamara and Troy while the lights go labyrinth of personal perversions and criminal on in corridors, waiting and recovery rooms, and underworlds in which no averagely conventional in the operating theater. They reveal a blend of situation appears ever to have existed, or which clinical setting with the most spectacular, inno- could not be found in other crime series that do vative decor imaginable, where elegance and a not need a medical setting, the series starts to five-star air predominate. It is a vision in which, head rapidly downhill, especially in the final three furthermore, a fast change in tempo have us seasons, until its demise became inevitable. abruptly suspecting that the entire medical at- Why did the scriptwriters choose that profes- mosphere will be nothing but glamor. It seems sion and that surgical setting to present two such vile and tormented characters? It is difficult to we will be watching the same sort of program as know, but I believe it was thoroughly unneces- always: will it end there, as usual? sary. Do they contribute anything to our aim to Dr. Troy is attractive, sexy, single, a woman- see if aesthetic plastic surgery appeared for the izer, narcissistic and a less-brilliant surgeon than first time as a central theme in a television series? his partner, though he is an excellent public rela- Personally, I do not think so. On the contrary. Be- tions man. Dr. McNamara is less attractive, mar- yond what could be an attempt to shine light on ried with three kids and the better surgeon of the certain themes that also fall within the sphere of two. Following the traditional, “good cop/bad this specialization (surgery on transsexualism, the cop” setup, Troy is the dark side while McNamara effects of morbid obesity and little else), the rest represents firm convictions. is the same as always: scars that appear to van- Thus, the premise is set up and the story be- ish as if by magic, body remodeling carried out gins, with episodes that each bear the name of using liposuction, and surprisingly fast recoveries the patient operated upon as a central theme. after surgery. Nevertheless, they try to give a feel- And at the beginning of each episode, the doc- ing of authenticity by introducing intra-operative tors always ask the same question: “Tell me what shots of cuts, visible wounds, blood, fat that is you don’t like about yourself”. It is a good line, but extracted in buckets from patients’ bodies, and too simple and even risky for initial intercommu- so on. All of this panders to the morbid fascina- nication with the patient in a consultancy of this tion of viewers, watching with divided attention type. The problem gets worse, moreover, when while eating dinner. In the end, nothing different we observe that none of the patients seems to or of value occurs to reveal the positive side of present problems or pathologies typical of a plas- aesthetic surgery or to portray it in a realistic way. tic surgery consultancy that might be called con- Even the patients who seek to recover their faded ventional. Each patient is increasingly strange or beauty or youth fall into addiction, seeking sur- unhinged. This confirms our initial fears. In fact, gery as their sole form of survival and showing the series opts to portray the frivolous side of the the most disastrous image possible to viewers. specialization. I would say it is quite unreal and The surgeons operate without masks, mak- even illegal on many occasions. ing surgery seem simple and easy while calcu- A plastic surgeon who undertakes aesthetic lating their profits. A mini-bar is on display in surgery is not the “achiever” of everything his the consulting room, while the doctors’ coats

-80- Notebooks of the Esteve Foundation Nº 42

Medicine in Television Series

are not even white but a strange tone of blue to narrator tells us how in 1987, after the infamous match the decor. The doctors immediately lead Black Monday crash, a new financial golden age their conversation with patients into personal ter- was born, and along with it, a new industry, the ritory. They insinuate or leave the field open for luxury industry. Newfound wealth coupled with their female patients to make sexual insinuations easily available credit opened the door to vani- in the consulting room. Are these doctors differ- ties and excesses once reserved for the rich and ent to others, or are they making an effort not to famous, among them, plastic surgery. The “new seem like doctors in front of their patients? This must-have status symbol” was a perfect body. is what happens when one wants to convey the In this narrator’s words: “compliant thighs and ti- idea that plastic surgery, at the end of the day, tanic tits”. At that money-earning peak of offering is not medicine or even surgery. One should not both the possible and unattainable, McNamara scare the patients. This goes beyond a doctor- and Troy rub their hands at the profits they earn patient relationship, into commercial territory, with each patient. They enlarge their consultancy, trivializing an operation’s risks, or pretending that furnishing it in luxury, and spend endless amounts the patient’s wishes must be served at all costs. on cars, yachts and the high life, thereby marking We even wonder why plastic surgeons on-screen their professional status in a medical specialization kiss their patients goodbye instead of offering a very different to others. It seems to allow plastic friendly but respectful handshake. surgeons to earn huge sums of money very eas- Leaving aside detective-style plots and situ- ily. No stress can be seen during surgery. They ations that are far removed from these plastic merely tote up their earnings for each operation. surgeons’ professional practice, we might even Yet when this fairytale ends and the international accept some degree of rivalry between col- credit crunch hits, the operations decrease drasti- leagues, professional jealousies, or even some cally as do their earnings. It is tough to maintain small stratagem to become the patient’s favorite. the world they have created, and even tougher to These things might be seen to a certain extent appear to be doing so. This is where the financial typical of medical competition and the quest for stress seems to turn these doctors human, and professional excellence. Viewers might even for- they start to feel anguish and stress they have give them such striving after perfection that ev- never shown in the operating theater. ery plastic surgeon carries inside. Not in vain did Are they a special case? Unfortunately, for the even Dr. McIndoe, mentioned in the introduction, series creators it seems not, because when an- say that in his work he felt God’s presence de- other colleague joins the firm for an episode or scending into his right arm. But doctors McNa- a season, we assume either “birds of a feather mara and Troy take all this to the limits of deceit, stick together”, or that the scriptwriters do not jealousy and destruction. Neither do they seem appear to believe anybody can practice this spe- to have much empathy with their patients. Some- cialization with a modicum of ethics or medical times they even clearly make fun of their com- professionalism. For example, in the first sea- plexes. McNamara, though we noted he is firmer son, Dr. Merril Bobolit, played by Joey Slotnick, in his personal convictions in early episodes than showed fewer scruples than the central charac- his partner, allows himself to be swayed in the ters and is able to undertake illegal operations, quest for the only goal his consultancy pursues: continue operating after losing his license and money and success at any price. Troy, who use anesthetic gases as a drug. Generally, any adores female bodies so much for his own plea- other plastic surgeon who enters McNamara and sure, creates beauty in his patients so as to then Troy’s consultancy is the same. They all seem to seek sexual relations with them. He is, moreover, link their profession to a disproportionate quest profoundly misogynistic, scorning and mistreat- for fame and money, and to a total lack of scru- ing women. ples to achieve them. What is interesting at the time of writing is Beauty, success and money seem to be the the sixth season’s opening episode, in which a ideal in plastic surgery, at the hands of handsome

-81- Nip/Tuck, Grey’s Anatomy and Plastic Surgery

young doctors like Dr. Troy, who throw out lines hold for the residents in training at Seattle Grace like “Appearance is everything”, “Beauty is hap- Hospital. They generally refuse to participate in piness, beauty is power, beauty is confidence”, surgery with Sloan while they fight energetical- or “Going against established beauty is to ignore ly to attend, even just to observe, in any other the world in which we live”. When these ideas are specialization’s operating theater. Is this a subtle stirred into such a risky fictional cocktail, I firmly way of saying that what plastic surgeons do is believe this reflects poorly on the reality of plastic not important? Is it a secondary specialization surgery. According to such tenets, this profession to choose to learn? Dr. Sloan is hard-pressed does not merely implicitly espouse the cause of to attract any resident who wants to follow his money and success for surgeons and patients, work, and when he does find someone, he in- but also flouts it ostentatiously. So these profes- vites them to participate not in his team but in sionals forget the aims on which the practice was what he calls his Plastics Posse, to the embar- founded, the work of its pioneers, and everything rassment of the resident selected, who sees no the practice can achieve, not just in aesthetic sur- special honor in it, rather a means of removing gery but in collaboration with most other special- them from true surgery. This is a curious view- izations in a large hospital. point, since in Spain, for example, the special- Despite Nip/Tuck’s success –more closely ization of plastic, reconstructive and aesthetic linked to its slick photography, morbid fascination surgery is every year more in demand by re- with excessive hyper-sexuality and the introduc- cently graduated doctors who have passed the tion of extreme themes– it does not help at all MIR exam (for Resident Intern Doctors). Training to present the reality of plastic surgery. Rather, places are quickly occupied by students with it completely distorts its governing foundations the best academic records. while promoting the most fictitious and unreal It is a shame that in this series too, what is stereotype of plastic surgery specialists. Medi- sometimes seen as a small glimmer of recogni- cine and the specialization operate as a mere tion toward the discipline of plastic surgery, or excuse in which to set the storyline and increase of publicizing the specialization’s novel and in- the morbid excitement of their patients’ increas- teresting aspects, ends up being lost in the ba- ingly extravagant requests. nality of the character of the plastic surgeon. He In narrowing the search for more appropriate seems friendly, but is never a leader among his sensitivities to the plastic surgeon’s work, there colleagues who have other, better recognized is more joy in the treatment given to the special- specializations. He ends up once more being ization in Grey’s Anatomy. The program’s plastic the good-looker, scorned and superficial, who surgeon is Dr. Mark Sloan. Though we might ex- easily performs less important operations. With- pect little from a plastic surgeon who, predictably out have taken advantage of the whole range of following the jaded stereotype of TV fiction, is options the specialization might offer in a series the most attractive doctor in the hospital, and such as Grey’s Anatomy about a large hospital, is dubbed by his female colleagues “McSteamy”, Dr. Sloan, who first appeared in the third season, in some episodes he represents plastic surgery’s was dropped from the series in the ninth. contribution much more faithfully. In the series we His place was taken by Dr. Jackson Avery, see cases of facial reconstruction after traffic ac- the only surgical resident who became Sloan’s cidents, micro-surgery, reimplants and children protégé, and to date he seems to uphold the with birth defects. Dr. Mark Sloan’s work includes moral values and medical practices common to far more than just aesthetics. It seems the pro- the other specialists. At some point it is revealed gram wants to introduce us to plastic surgery’s that his choice of plastic surgery may have been more useful side, including collaboration with consistent with his good breeding. Not for noth- other specializations. ing is he the grandson of one of the country’s However, it does call attention to the lack of most reputable surgeons. His family owns an im- attraction that the surgery he conducts seems to mense fortune, thanks to which they are patrons

-82- Notebooks of the Esteve Foundation Nº 42

Medicine in Television Series

of one of the country’s most significant medi- pursues. The surgeon’s experience and skill are cal prizes. Nevertheless, he seems to maintain fundamental, but possibly more than in any other a straight professional path while, like Sloan, he specialization, a connection with the patient is tries to attract one of the new residents to the fundamental in order to recognize the latter’s ex- Plastics Posse. Such sound professional judg- pectations and offer her or him the most realistic ment by Dr. Avery seems to have shrunk his solutions, or to know when to refuse if such ex- participation as a specialist and the presence of pectations are unrealistic or unhealthy. The plas- pathologies typical of his specialization in the se- tic surgeon must get inside his or her patients’ ries. Meanwhile, given the show remains on air, minds, recognize body dysmorphic disorders we hope for plastic surgery to feature once more and help patients to see that, to paraphrase the on the small screen at some point. And if not French mountaineer, photographer and filmmak- portraying it better, at least it may have the same er Louis Audoubert: “As far and wide as we travel degree of reality, professionalism and interest as the world seeking beauty, we will never find it un- the other specializations. Perhaps Dr. Avery will less we carry it with us”. manage to attract one of the many female doc- It is true that private exercise of the specializa- tors starring in the series into his specialization. tion enables plastic surgeons to develop a more This would shatter another myth that only men lucrative professional activity since aesthetics is work as plastic surgeons, above all in aesthetic one of the few medical activities that falls outside surgery –a specialization belonging to men who of health coverage and health insurance. But sculpt beauty in women. There is scant need to this does not make plastic surgeons mere skillful recall the current growing dominance of women businesspeople trading on their patients’ health in medicine, in Spain and worldwide. In this sec- at any price. We should not allow the superficial- tor as in others, reality takes one path while fic- ity of the image that to date has predominated in tion takes another. A woman surgeon in the con- film and TV fiction of plastic surgery operations. sulting room would not perhaps offer so much Nor should the model of its professionals obscure morbid fascination when creating storylines and the reality of a magnificent specialization that ful- less dramatic play in episodes. So would only fills in its deepest sense the definition of health the professional viewpoint remain? Would there established in the Preamble of the Constitution of not be so much room for parallel storylines of sex the World Health Organization: “a state of com- and fast cars? Perhaps the resulting character plete physical, mental and social well-being and would be too boring. not merely the absence of disease or infirmity”. Yet it is not just film and television that should convey that image. Plastic surgeons themselves Conclusions are responsible for this image we present to so- As Gaspar Tagliacozzi, one of the pioneers in ciety and to make our practice a reflection of our plastic surgery in the Medieval period, wrote in professionalism, undergoing constant training his work De curtorem chirurgia per insitionem, in a state-of-the-art, innovative specialization. published in 1597: “We restore, repair and make Neither do we want to resemble the stereotype whole those parts of the face which nature has that fiction portrays of us, nor imitate its frivol- given but which fortune has taken away, not so ity, trivializing the surgery we perform, its visible much that they may delight the eye but that they ostentation and luxury, or constantly appear on may buoy up the spirit and help the mind of the programs of frivolous scientific dissemination or afflicted”. in celebrity magazines. If not, we ourselves will If in any use of medicine one works with and ensure that we continue to be viewed as simple for the human body, in plastic, reconstructive and dream merchants, creators of beauty to clothe aesthetic surgery, the raw material is the human humanity. We will lose people’s respect for a body itself: to reconstruct it and give it beauty great specialization that perhaps we have not and functionality are the aims this specialization made known in its true dimension. We are still in

-83- Nip/Tuck, Grey’s Anatomy and Plastic Surgery

time. Otherwise, let us not forget that even after −− McCarthy JG. Introduction to plastic surgery. In: Plastic his death, Tagliacozzi was condemned for inter- surgery, vol. 1. Philadelphia: W.B. Saunders; 1990. p. 1–68 fering with God’s creation, and his body was ex- −− Mosley L. Faces from the fire: the biography of Sir Archi- humed and re-buried in unconsecrated ground. bald McIndoe. London: Weidenfeld and Nicolson; 1962. −− Preamble of the Constitution of the World Health Orga- nization. New York, 22 July 1946. Official Records of the References World Health Organization, Nº 2; 100. −− Programa de la Especialidad de Cirugía Plástica y Re- −− Audoubert L. La gran travesía de los Pirineos. Barcelo- paradora, Secretaría de Estado de Universidades e In- na: Juventud; 1995. vestigación del Ministerio de Educación y Ciencia. Re- −− Canal Odisea. McIndoe: cirugía reconstructiva en la II solución 15-7-86. Updated in 1996. Guerra Mundial. −− Sociedad Española de Cirugía Plástica, Reparadora y −− Canal Historia. Archibald McIndoe and the Guinea Pig Estética (SECPRE). Available at: www.secpre.org Club. −− Tagliacozzi G. De curtorum chirurgia per insitionem. Ve- −− Coiffman F. Cirugía plástica, reconstructiva y estética. nice: Gaspare Bindoni; 1597. Bogotá: Amolca; 2008. −− Vilain R. Jeux de mains. Paris: Arthaud; 1992.

-84-