Three Rivers

Given how miserable is the experience of being a hospital patient, we seem to have an inordinate appetite for watching it happen to other people. Hospital dramas and melodramas have been a staple of US television since Richard Chamberlain started checking pulses as Dr Kildare back in the Kennedy era. And with a glut of such shows about to arrive on Irish screens, never before have the American networks sought so much medical help, with an apparent shift of emphasis from the doctors to the nurses.


Edie Falco – Carmela from The Sopranos – takes the title role in Nurse Jackie, a blackly comic drama about an adulterous, pill-popping New York nurse which has already fallen foul of both Christian groups and nursing bodies. Acquired by RTé for this autumn, it's been a big hit for its makers, Showtime, the subscription channel that also brings us those other morally screwed shows Dexter, Californication and Weeds. Indeed, New York magazine reckoned Nurse Jackie was "the best series yet in the cable channel's ongoing meditation on the nature of addiction... and the setting for a truly breakthrough female character".


Nursing bodies presumably approve wholeheartedly of Christina Hawthorne, the eponymous protagonist of TNT's Hawthorne – a paragon of a head nurse: a beautiful widow who sticks up for her patients and staff, even championing the janitor when he complains that the hospital bean-counters have made him switch to a cheaper brand of disinfectant.


Hawthorne is played by Jada Pinkett Smith – Mrs Will Smith – and her saintly healthcare worker stuck in the throat of the New York Times, who reckoned: "Hawthorne is mostly, it seems, intent on promoting the self-regard of its star, who also happens to be an executive producer on the show."


CBS's big new medical drama, Three Rivers, is one of the most eagerly anticipated of this season. This one's about transplant doctors – and it is apparently earnest and contemplative, posing ethical questions as it considers the viewpoints of donors and those receiving their organs. CBS has given it the primetime Sunday-night slot and TV3 has acquired it for its autumn schedule (along with NBC's Trauma, which stars Derek 'Antwone Fisher' Luke and Cliff Curtis as San Francisco paramedics).


You wonder how realistic the transplant scenes in Three Rivers are going to be. ER broke the mould of TV medical dramas when it came to the gory details of emergency healthcare. "We wanted to show what it was really like to be a doctor in an emergency room, the explicit surgeries, successful and botched," recalls Dr Fred Einesman, ER's former medical adviser. "In the beginning we said 'that's too bloody to show', or 'we can't use technical medical jargon'. But not for long."


But if the blood and guts, as well as technical realism, are reaching ever greater extremes, there is arguably one form of realism that is still not being addressed – the socio-political realism of the US healthcare system. As President Obama struggles to turn his healthcare reforms into law, there is a gap in the market for a medical version of The Wire. Laura Fries from Variety magazine, however, argues that the changing face of US medical care is gradually being addressed.


"I've enjoyed USA Network's new show Royal Pains, because it looks more closely at the failings of the American health system," she says. "The lead character [played by Mark Feuerstein] is a doctor kicked out of a prestigious hospital because he helped an uninsured patient over a wealthy hospital-board member. His new practice works outside of the usual medical norms – almost going back to the days of home visits and personal care.


"In fact, I would wager that we'll see more medical shows that will work outside the traditional format, sort of reinventing the rules as the rules for healthcare, especially in the US, seem to keep changing."


Reviewing the latest crop of medical dramas, Fries's colleague Brian Lowry sounds a more caustic note about the way TV medical dramas soft-sell the realities of the US healthcare system. "Thankfully, patients [on TV] seldom have to worry about filling out tedious medical forms, being grilled about insurance coverage or suffering from a prior condition," he says. "Getting their doctors to see them on a moment's notice is never an issue. And their insurance companies are presumably more than willing to pay for any and all medical care.


"Come to think of it, perhaps the Obama administration should enlist TV writers and the medical consultants that they employ to take the lead in revamping the healthcare industry."