The Truth in Scrubs

By Laura Zimmermann | 2.05.07

When people learn I’m four months away from graduating medical school, they undoubtedly ask me one of two things: what kind of medicine am I going into and which medical television show is the most realistic. Maybe ER or Grey’s Anatomy? My answer: Scrubs.

Yes, Scrubs. Everyone has a different incredulous reaction to this. Some chuckle, some frown, some ask, “Seriously?” in a high-pitched voice. But – seriously – beyond the slapstick humor and fart jokes, this series captures the medical profession in a surprisingly complex way that I didn’t appreciate until after I was on the hospital wards for a year and a half. What first appeared to be written into the show for the sake of humor – the quirky idiosyncrasies of the characters, the harsh interpersonal exchanges, the all-pervading social ineptness of the most senior characters – are actually basic motifs of social interaction in the hierarchy of inpatient medicine.

[***Editors' Note: Need a refresher about medical hierarchies and the cast of characters on Scrubs? No problem; we've got you covered. Jump here or here.***]

Truth #1: The (Approval) Carrot on a Stick

Dr. Kelso to Elliot: Sweetheart, if I wanted you to give me three wrong answers in a row, I’d just ask for “the usual.”

“Pimping” is so-called medical tradition; it entails rapid-fire, knowledge-based questions directed at a resident or medical student in the presence of peers and often the patients you’ve been trying hard all day to look competent in front of. Being “pimped” is just one of many ways in which medical trainees strive for the approval of their superiors. Forget food, forget sleep – approval. Medical trainees are perpetual students looking for report cards; after twenty years of conditioning (school), this is what we do best.

Scrubs does a very decent version of morning rounds that hearkens straight to the heart of anyone who’s been in the pimping hot-seat. On morning rounds, the Chair of Medicine, Dr. Kelso, “pimps” the interns (first-year residents), which include main characters JD and Elliot. From across the small cluster of people eagerly clutching their clipboards and hanging on Dr. Kelso’s every word, Elliot is singled out with Kelso’s eagle eye. Elliot returns his gaze with a pitiful yearning and a naïve hope that she will actually give the correct answer. This is the carrot: the gleaming, shining opportunity to impress her superiors and distinguish herself from her peers. The shiny prize that flashes from the haze of vital signs, CT scans, and two hours of sleep.

The question is launched from Dr. Kelso’s stern façade. And like most of us actually in medical training, Elliot’s delivery conforms to an arc. The face relaxes and the eyes fall as the mind fishes out the material to form an answer. Eyelids rise, eyes brighten, the voice begins strong with the first few syllables of the coveted answer that promises so much glory.

Then, as the eyes focus back on the questioner and Great Judge, a parallel thread begins in her mind as Elliot tries to read the reaction on Dr. Kelso’s face before her answer is even complete. Am I right? What is he thinking? What page was that on? Please let him be talking about what I think he’s talking about. With no signs of non-verbal confirmation from the other side, her voice drops in pitch and volume, trailing into nothing as she completes her answer.

This is where the show takes some satirical license, but the overall effect is the externalization of what most doctors-in-training really experience internally while being pimped. Dr. Kelso, maintaining the same piercing eagle eye and clamped lips that concluded the question, does not react. Probably three seconds pass without him outwardly showing any registration of the answer, but it is an eternity to the intern waiting for the Chief of Medicine’s verdict on her answer – which is actually a verdict on her entire life.

Finally, the crushing blows that Scrubs is known for. Instead of a simple “correct” or “incorrect,” Kelso breaks his cruel silence with a sarcastic comment that at first patronizingly caters to the answer. It sounds like Elliot’s answer might be correct … The Carrot. And, here’s the stick: As Kelso goes on, his response builds to an elaborate demonstration of how absurd her answer is. By the end of his tirade, Kelso not only blows Elliot’s answer out of the water, but comments on her overall intelligence, her childhood, and what she’s wearing.

Truth #2: The Worker Bee

One of the best parts of the show is that the medicine interns JD and Elliot are rarely called by their real names. When training to be a doctor, you have no personal identity in the hospital. It’s something you actively fight to establish when you first arrive and you struggle daily to maintain, although the struggle gets slightly easier as you move from medical student to intern to resident.

The nurses don’t know your name and don’t ask (YOU have to introduce yourself – politely and with the appropriate humbleness; see Truth #4). It may be days before your attending remembers your name. This may not seem like a long time, but if you spent 13 hours per day with someone anywhere else, you can bet they would remember your name. Plus, we’re talking about a person who has committed millions of facts about physiology, pharmacology, and disease to memory. The fact is, they don’t care enough to remember your name until you’ve proven yourself useful to them. And yet, despite being both invisible and anonymous, you must also be omnipresent, constantly buzzing about the hospital taking care of patients. This means knowing everything there is to know about their diseases, and keeping up with all their procedures, tests, ongoing symptoms, and discharge issues. Plus, you’ve got to be totally accessible to everyone above you in the hierarchy (should they chose to grace you with their attention), 80 hours per week.

Dr. Cox, the hard-ass, emotionally-stunted attending, calls JD a different woman’s name or female-nuanced noun (like “Tiny Dancer”) throughout the length of the show, never actually referring to him as “JD” or “Dr. Dorian,” although JD is a 26-year-old doctor. His attitude towards JD is not only de-humanizing, but also infantilizing. Interns have been in school for two decades by the time they get to the hospital, and all the degrading and diminutive connotations that cling to the term “student” don’t dissolve overnight. It’s apt that Dr. Cox’s only departure from women’s names is to refer to JD as “the kid.”

Dr. Cox and Dr. Kelso refer to Elliot exclusively as “Barbie” and “sweetheart,” which of course rings true in a way; as a woman training to be a doctor, you’re always going to run into an old-school male doctor or two whose default concept of you is Barbie until you prove otherwise.

Another layer of personal vulnerability seems to come with the transparency that every medical trainee takes on at the hospital. It’s a rather unfair one-way mirror. Those above you in the chain of command seem to be able to predict every miserable detail of your existence in and out of the hospital, while they maintain an impenetrable aloofness that you will only achieve when you get to their position. They’ve seen it all: the pimping, the dying patients, the sleep deprivation, spending every waking moment with your colleagues in the hospital. And, every so often, they let you know what they know.

Dr. Cox looking at Elliot and JD: Bravo, just a big bravo, heaven help me I love newbie theatre. Honest I do, it’s the way you both play your parts with such wonderful commitment, that almost had me believing that you aren’t having whiny, neurotic, extremely pale sex with each other!

Truth #3: Masochism

In medicine, everyone’s a martyr. Well, not everyone – just the medical students, residents, and doctors. The nurses are usually a little smarter; they join unions and follow work-hour laws and rarely volunteer to do anything beyond what’s in their job description (partially because, frankly, what isn’t in their job description?).

When you train to be a doctor, however, you become a person who will skip a couple hours’ sleep (of the four total available to you) just to study up for the opportunity to be pimped, although it’s supposed to be so you can take better care of the patients. You’ll become the person who never eats lunch before four o’clock in the afternoon. You’ll become the person who subsists entirely on cafeteria pastries and coffee. You’ll also encounter – and become – one of those people taking on awful work as long as it bolsters their evaluations and gets them noticed by the attending. Again, the approval thing.

In one episode, Elliot is trying to get Dr. Cox to notice her (fighting for her identity), and there is a scene where she walks up to JD and Carla, the RN, sobbing. As concerned friends, they ask her what is wrong. Beaming through her tears, Elliot answers, “Dr. Cox let me tell a woman her husband is dying.”

I remember studying it in psychology class in college, something akin to the Stockholm Syndrome. The abused actually believe that they deserve to be abused and are somehow grateful to the abuser. We’ve all pulled more than a few Elliots during medical school; practically begging to put in a naso-gastric tube fully knowing the patient would most likely puke all over me – and he did.

That’s medicine.

Truth #4: The Nurses are Actually Running the Show

This is absolutely true in the hospital, and it’s true on Scrubs. In one of the very first episodes, Elliot finds that one of the nurses has made a mistake on one of her patients. She points this out to the nurse in a somewhat stern manner, only to find later that none of her tests or blood draws are getting done. Care for her patients grinds to a halt. It’s true that if you piss off one nurse (and, it’s not hard to do), you quickly gain a rep among the nursing staff, and each one will fight you tooth and nail over the simplest orders. A patient is suddenly spiking a fever and you need a blood culture. Someone else has had diarrhea for two days, and you need stool samples. What you need is the nurses because they do all of that. The doctors may come up with the plan, but the nurses carry it out.

The nurse’s power is all-pervading; you often find that they have the ear and the respect of your superiors, often more so than you – at least until you prove your usefulness. On Scrubs, while the interns can barely get their superiors to use their real names, Carla has the ear of both Dr. Cox and Dr. Kelso. They respect her, ask her for advice, even yield to her demands. In one episode, Dr. Kelso (the Chief of Medicine, mind you) approaches the nurses with a sugary-sweet “How are my girls?” only to be shut down by Carla. “If you’re about to start one of your ‘how are my girls? and this is what you can all do for me,’ stop, because I am in a mood.” She walks away unscathed, while a pre-emptive rant from any one of the interns would have certainly been followed by fierce and well-deserved retribution from on high. In another episode, Dr. Cox even sneaks back into the hospital on his night off to ask Carla for relationship advice. In medicine it’s often true that attendings reward nurses for hard work by showing their human side.

Truth #5a The Sharks Versus the Jets

It’s true that there is a divide in medicine between medical doctors, who use medicine and behavior to treat disease, and surgeons, who use surgery to treat disease. The two groups have been compared as “thinkers” vs. “doers,” “incompetent” vs. “saviors,” “compassionate” vs. “assholes.” The comparisons run the gamut, but one of the most apt characterizations of the relationship between the medicine and surgery worlds is a clip in which JD describes the relationship: “You see, the surgical and medical interns are kind of like two rival gangs.” The surgical interns round the corner at the other end of the hall. “Not real gangs; more like those cheesy gangs you see in Broadway musicals.” The medical interns gather in the middle of the hallway. The two groups step into formation, and the camera gives you a glimpse of one and then the other snapping their fingers and pirouetting toward one another while the surgeons chant. It is the perfect caricature of the medicine vs. surgery rivalry in that it captures the mindless dogma, unabashed nerdiness, and pretentious self-involvement of the two camps. The utter obscurity of details often argued over would baffle anyone not in medicine.

Scrubs - West Side Story

Truth #5b Surgeons Think They are God

Turk, holding up his hands: See these?!?! I can do whatever I want because of these!

This truth is only partially true. Some surgeons think they are God. And you can kind of see why. To save a patient’s life, they sometimes have to take patients to the utter brink of death, and it’s their personal responsibility not to let the patient fall off that cliff. They often have to perform what I’ve considered amazing feats when I’ve had the privilege to see them – for instance, repairing a crucial artery – tiny on a physical scale, but huge on a survival scale. Surgeons are also particularly amazing because in a crisis situation or unforeseen circumstances, they have to be able to single-handedly lead the entire surgical team out of the wilderness.

One Scrubs clip captures the admiration and praise for surgeons that is sometimes almost tangible. Turk has just successfully repaired an artery without an attending present (I’m not sure how realistic that is, but we’ll let that one go for now). Anyway, before the surgery, Turk is sheepish and afraid that he’s not going to be able to handle calling all the shots. After the surgery is a success, there is a pendulum effect, and Turk’s cockiness is priceless. The scene captures the surgeon machismo perfectly, with Turk strutting in with Carla on his arm, singing a rendition of “Shaft,” only it’s “Turk,” and all of the back-up singers are female nurses, medical residents, and patients.

Truth #6 Absurdity is Sanity

The show’s humor hinges on the strange reveries JD slips into throughout the day in an attempt to deal with his surroundings. One of the great defense mechanisms in the hospital is creating humor where none exists, be it through fantasy, exaggeration, or gallows humor (“Oh, that is so awful!”). In one scene, JD is attempting to communicate with a patient who speaks exclusively German. The patient has pancreatic cancer, and JD is charged with the task of telling him that he will likely die soon. “I just wish there was some way we could connect…” While grappling with how to overcome the language barrier to have one of the most dismal conversations in medicine, JD imagines himself and the patient dancing in the hospital room to Nena’s “99 Luftballoons” while red balloons fall from the ceiling.

First, the obscurity of the reference is classic nerdy medical humor; leave it to a doctor to come up with and appreciate the convoluted connection between an elderly German man and Nena’s 99 Luftballoons. Second, the absurdity of dancing with a patient in the middle of a balloon-filled hospital room is not only funny, but is secretly the hope of anyone taking care of a terminal patient. Who among us hasn’t fantasized about a dying patient miraculously getting up and dancing out of the hospital to re-join their families and go on with life? Not to mention the dancing symbolizes a vicarious indulgence of our need to connect with patients on a more human level.

I understand why people are so surprised when I say that Scrubs is the most accurate medical show. If I’d never worked in the hospital taking care of patients, I would never have believed it either. From the official NBC website, you can’t tell if they were really going for the accuracy angle. As they describe it, “’Scrubs’ focuses on the strange experiences of J.D. (Zach Braff, “Last Kiss,” “Garden State”), a medical resident, as he continues on his healing career in a surreal hospital, crammed full of unpredictable staffers and patients -- where humor and tragedy can collide at any time.”

DVDVerdict.com writes, “Series creator Bill Lawrence set out to create a series that was more honest about the realities of being a medical intern than any of the myriad other medical TV shows on the air, past and present, and what he came up with was a weird but irresistible mixture of hyperrealism, sentiment, realistic drama, and downright goofiness.” Lawrence was apparently inspired by war stories from old-college-friends-turned-doctors, which might explain why the show’s underpinnings are so true to life.

If you’re lucky enough not to have spent much of your life surrounded by medicine, most of what you know about doctors and hospitals probably comes straight from Hollywood. Scrubs presents stereotypes that are more true to life than many of the TV and movie-perpetuated clichés that have come to be accepted as truth about doctors, nurses, and hospitals. But more importantly, it goes beyond these truisms, using tongue-in-cheek humor and hyperrealism to explore what stereotypes do not capture: the personality and vulnerability of every person working in the hospital. Its most important lesson is to reveal that while a hospital might be a place where “miracles” happen and life-and-death matters arise hourly, it is still a workplace. Like Office Space before it and the Office after it, Scrubs takes the nitty-gritty details of the daily grind, and amplifies them to a roaring hilarity, accurately paralleling the roar of the blood pumping through an intern’s racing heart the first day on the job.