Tuesday, March 31, 2009

ER Week - Day 2

Now that we’ve dealt with the larger arcs in the pilot episode of ER, let’s take a look at several scenes that manage to reveal a lot about their characters in interesting ways.

A standout scene midway through the pilot is a moment between Dr. Lewis and a patient played by Miguel Ferrer. In the first scene, the patient mentions he’s smoked two or three packs a day since he was 14. Lewis goes out into the hall to call her boyfriend and while she’s on the phone, she receives the patient’s chest x-ray. What she sees is clearly not good, provoking a spontaneous “Damn” in mid-conversation. She ends the call, saying, “I have to tell a patient something” and that “something" is clearly not good news.

When she returns to the patient, her mood is decidedly formal. Clinically, she tells him “There’s something abnormal in the structure of your lung.” He asks what it could be and she responds:

LEWIS: Well, it could be any number of things, an infiltrate, a dense area of tissue from an old infection, it could be an inhaled foreign body, it could be a granuloma [note: I’m not at all sure that’s spelled right] of some sort. It could be a lot of things.

(It’s unclear if this blocking was in the script, but at this point, Lewis moves away from the x-ray and goes to the chart, which means she’s got her back to the patient.)

PATIENT: What do you think it is?

LEWIS: There’s no way to know. You’ll have to undergo a bronchospy and possibly exploratory surgery before we know for sure.

PATIENT: I understand. But… what do you think in the meantime. Just—

LEWIS: I think in the meantime, you should consider it a potentially serious finding.

PATIENT: So you’re saying I got cancer.

LEWIS: I’m not saying that. I’m saying we don’t know anything for sure.

PATIENT: Doctor, let me just explain something to you, okay? I’m 40 years old. I have a wife. I have three children. I have a house that isn’t paid for. I have a mother who has a house that isn’t paid for. I have a lot of responsibilities, so I need to know, I need to know what you think.

LEWIS: I think you should regard your condition as very serious, but should await a final determination.

PATIENT: I don’t understand the problem. Is it so hard? Are you afraid to tell me the truth?

LEWIS: Your history of coughing blood, weight loss, and this X-ray is suggestive of cancer, but the diagnosis has not been confirmed and it may very well be something else and none of us should jump to any conclusions until we know. That’s what I think.

PATIENT: How long do I have?

Lewis looks at the x-ray, considers it a moment.

LEWIS: Six months to a year.

PATIENT: Do I have six months for sure?

LEWIS: No, not for sure.

There’s a little more to the scene after that, but that’s the important part. Notice the conflict in this scene – the Patient wants a straight answer that Lewis can’t provide. Lewis, with her experience, knows what the x-ray is telling her, even as she knows that there are other procedures that can be done to confirm the cancer diagnosis beyond a reasonable doubt. Are there other explanations for the mass in the x-ray? Yes, but clearly from Lewis’s reaction, she’s pretty damn sure of the cancer diagnosis from the start. The subtext is that she doesn’t want to deliver the bad news, and she’s urging him to get other tests done not just to rule out the less likely causes, but also so someone else will have to deliver the bad news.

Essentially, Lewis’s conflict is that she has information she doesn’t want to share, and her medical ethics seem to be giving her an out. There’s justification for telling the patient to have further testing done, so she pushes that. She avoids giving a straight answer. Notice how carefully she chooses her words when she gives the initial diagnosis. She’s trying not to alarm the patient with a cancer diagnosis, and yet, it’s having the exact opposite effect. Generally, the more carefully a person phrases their speech, the more likely it is that they are trying very hard NOT to say something. The patient keeps pressing, calling her out on this until she has no choice but to deliver the bad news.

In my opinion, this scene isn’t just an example of great writing, but great acting. Check it out if you can. And for those actors out there, it might make for an interesting scene to perform in an acting class or an actors workshop.

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