There's this genre of content that's just people sharing their lives, telling stories about their lives, that I'm finding more of and enjoying these days.
There's the French woman on here who owns a private little farm in the mountains and has some llamas and cats and a donkey and a dog. She writes about her animals in such a human way and, I mean, pictures of llamas.
Just watched a yt vid of an older American man (who I was following years ago for woodcarving tutorials) walking through his parents' farm, telling about all the different features of it (they had animals AND a creek AND some forest AND a garden and they were 4 brothers. What fun it must have been.) and it was just so peaceful and interesting to hear about his childhood.
It’s a very wholesome kind of content, but the key is that it’s presented in an unpretentious, modest way.
This post is part of a series on the Anatomy of a Medical Drama.
The first thing to know about House, MD is that Dr. Gregory House is One Cranky Jerk.
The second thing to know about House, MD is that it isn’t a medical drama.
Oh, sure, it pretends to be. We get all the furniture of a medical drama: the dying patients, the worried family members, the gruff attending physician, the compassionate and sensitive younger doctors. We get death and we get life and we get medical miracles.
But that’s not the true genre of House.
House is a detective show. In fact, it’s a medical adaptation of the classic Sherlock Holmes.
Instead of a doctor, I want you to consider Greg House to be a detective. (Even the name House is supposed to get you to think of Holmes.) He’s arrogant, he’s rude, he’s problematic — and he’s brilliant.
Instead of a disease, I want you to consider whatever improbable virus, condition, or disease to be a criminal, a devious mastermind out to do harm. The symptoms, the actual disease process, are thus its crimes, and the patient is its victim. The loving family members are witnesses to the crime with valuable information for our detective, while the junior doctors, House’s intrepid fellows, are the junior detectives.
Lisa Cuddy, the hospital’s chief administrator, plays the role of obstructor and leader. She’s the less-than-brilliant chief who’s supposed to see things done the “right” way. She is the Lestrade to House’s Holmes; she’s there to get in his way.
And what would a Sherlock Holmes be without a Watson, or in this case, a Wilson? A best friend who enables and supports our main character not because he doesn’t see his flaws, but because he loves him in spite of them?
House, my friends, is a crime drama.
Thus we’ve discovered House, MD‘s Content Genre: Crime Drama (Medical), also known as a Diagnosis Drama.
The Reality Genre of the show is aimed to be Realistic, grounded in reality and the cutting-edge medicine of the day. The rules of the world are ostensibly the same as the one you and I live in: magic, elves, and science fiction take no part in this show. That said, the show’s connection to actual realistic medicine is tenuous at best, as we’ll discuss below.
What Makes House, MD Great?
There are a number of things that contributed to House, MD‘s success over its eight-year run.
First, the acting was great. Hugh Laurie brought depth and a tremendous amount of weight and poignancy to the character of Greg House. The supporting cast, including Lisa Edelstein (Cuddy), Robert Sean Leonard (Wilson), Jennifer Morrison (Cameron), Omar Epps (Foreman), and Jesse Spencer (Chase) made the first few seasons absolutely riveting, and adding in talent like Olivia Wilde (Hadley / “13”), Kal Penn (Kutner) and Peter Jacobson (Taub) in later seasons only improved things.
Second, House’s mindset is absolutely fascinating: Everybody Lies. (The question that makes things interesting is how they lie, to what degree they lie, and, most fascinating of all, why they lie; this is part of the fun of House, MD as a show.)
House has been criticized for being formulaic, and I can definitely agree that it is, and yet something in the formula that drove the show was incredibly compelling. House was always doing something absolutely crazy that we knew was wrong (because the episode was only half over), Cuddy and his staff were always trying to keep him on the sane and level path, and what’s even better, the show recognized it. It was acknowledged in multiple episodes, and even by House himself, that his colleagues were the reason House could stay sane and keep from killing his patients.
In fact, House and Wilson fall into (or at least adjacent to) the “Buddy Cop” trope, what Roger Ebert called a “Wunza” relationship: one of the pair is a calm, competent, mild-mannered oncologist, while the other is a dramatic, abrasive, neurotic, brilliant critical care doctor. It doesn’t contain all aspects of the traditional Buddy Cop relationship — we don’t see them hate each other in the beginning like we do with most buddy cops — but the relationship is there; we see it after it’s stabilized.
And that drama, that tension between the egomaniac with a syringe and a helpless patient and those who want the best for both of them, made House an incredibly tense show. That tension carried us through to the inevitable end — that House would solve the case, the patient would get better, and because the patient got better, all would be forgiven.
House also had consequences for the character’s actions that played out over multiple episodes. At the end of Season 1, House is shot because he was such a jerk — which resulted in his getting a certain kind of anesthesia (ketamine) which eliminated his pain and gave him the ability to walk and run pain-free again for a limited time at the start of Season 2.
House’s unorthodox treatments (such as prescribing cigarettes for Irritable Bowel Syndrome) landed him in hot water with Medicare, which threatened to pull his license. His constant abuse of drugs, a cornerstone of his character, landed him in rehab more than once, and addiction is a theme that plays its tune throughout the show.
All in all, House was a very good show with a lot of strong qualities.
Where Does House, MD Fail?
First, we need to get something out of the way: we get a lot of racism, sexism, homophobia, transphobia, etc. from House himself — he is, in a sense, the show’s social villain. He’s portrayed as a man so offensive that the only reason he keeps his job is because he’s too brilliant to fire for his childishness and gruff exterior.
That said, hearing some of the awful and offensive things he’s said come from a “medical professional” and the show’s protagonist is damaging and hurtful. There were ways the showrunners could have made House a jerk without resorting to insults based on someone’s identity.
(It’s also worth considering its place in time; the show ran from 2004-2012, an era in which minority voices were far less recognized in TV than they are even five years after the show’s end. )
The show fails the realism test on several fronts. In fact, speaking as an ICU paramedic, the medicine is often laughably inaccurate or hyperbolized. Things progress at a pace that suits dramatic storytelling, not reality; diseases layer that are astronomically unlikely; hell, House’s entire specialty — “Diagnostic Medicine” — doesn’t exist, because all doctors diagnose and all doctors treat.
But that’s not the big problem with the show. The biggest problem with the show are its ethics.
The number of unethical and outright illegal measures House takes to “get the job done” would have gotten any real doctor fired in their first year. They are, frankly, a scary thing to normalize in the minds of non-medical viewers.
Speaking of getting fired, fun fact: while medical staff who come to their employers and admit addiction to a substance are generally treated well — [estimates of substance abuse among nurses run from 10-20%] — they’re not allowed to practice stoned. Many employers will give time off for rehab, but staff must be compliant to practice.
Moreover, the repeated displays of unpunished bad behavior lends itself to a mindset that “the ends justify the means,” which is incredibly dangerous. A great many awful things have been “justified” in this manner.
Is It Good TV?
This is the most irritating part about House. Because with as many inaccuracies and flaws and mixed messages and damaging representations as the show has, as many bad stereotypes as it engaged with — it was still damn good TV, at least for the first 4 seasons. Characters changed, at least a little; the stakes were constantly escalating; House the Bully was often, let’s face it, hilarious in his cruelty.
House might have been bad in a great many senses, but it was damned compelling TV, and for all its faults, that fact is undeniable.
In short: House is great to watch, but don’t try to be a Greg House.
How Can We Write Like House?
If you wanted to produce a book, movie, or TV show along the lines of House, MD, my first suggestion would be to get very, very comfortable with the genre conventions and obligatory scenes of the crime drama, and consider how they can translate into medicine.
If we truly want to classify House, MD, we would likely call it a diagnosis drama to differentiate it from a crime drama, though really all that’s changed is the furniture.
Here are some of the Obligatory Scenes and Genre Conventions for a diagnosis drama, and the parallel scenes in a crime drama:
The Disease Strikes. (The Crime) Whether something has been building up for a while or comes to a head, we need to see a character felled by a disease or injury. This must occur early in the story/plotline and is essentially the Inciting Event.
The Doctor & The Team. (The Detective & Sidekick(s)) We must have a lead character, usually a doctor, trying to solve the medical puzzle, usually working with a team. The interpersonal dynamics of the team are crucial to establishing drama and hooking the audience.
Gather Symptoms and Information. (Interviewing Witnesses; Red Herrings.) The doctor must try to gain as much information as they can to solve the case. In House this often involves burglary for reasons not entirely clear.
Diagnose / Treat / Fail / Repeat. (Red Herrings & False Accusations) As the drama wears on, the patient gets worse, often by the hands of the doctor treating them. The team iterates over their work, trying new approaches that must get riskier and more dramatic as time goes on.
It Gets Personal. There must be some reason the doctor (and thus our audience) becomes closely entwined with the outcome of the case. Either the patient and doctor or team must form a personal bond, the doctor’s reputation must hang in the balance, or the rising tension between the team (who must think differently from the doctor) can only be resolved by solving the case and helping the patient.
The Final Diagnosis. (J’accuse!) The doctor must make a final diagnosis that will either save or kill the patient.
A Life Saved or a Life Lost. (The Justice Theme) Our story must end with either the patient’s life being saved or their life being lost. This may come with an ironic twist: the doctor may save the character at the expense of a relationship they value dearly.
If you’d be willing to take a piece of advice, though… check the misogyny, racism, homophobia, transphobia, etc. at the door. Take the best things from this show, not the worst.
For more reading on genre conventions and obligatory scenes, I recommend Shawn Coyne’s excellent guide to editing, [The Story Grid], and Blake Snyder’s [Save the Cat!], both of which are excellent books on storytelling from wildly different, and yet similar, perspectives.
What Medical Drama Should I Analyze Next?
Drop a comment or reblog and let me know!
xoxo, Aunt Scripty
[disclaimer]
[Free Email Course: Injuries in Storytelling]
Anatomy of a Medical Drama: House, MD was originally published on ScriptMedicBlog.com
(This post is an excerpt from the upcoming Maim Your Characters)
What’s Your Content Genre?
Genres in fiction are the promises you make about the story you’re going to tell.
They’re a mutually shared set of expectations between you and your readers.
If you put a skull and crossbones on the front of your novel, there had better be pirates inside, preferably on the first page.
If there’s a spaceship, your readers would be very mad to find their story set entirely in a jungle in 1930s Congo and a distinct lack of aliens.
And iIf you put a cartoony cover of kids playing in a park on an erotica novel, monster is the kindest thing you will be called.
Genres tell readers what to expect. In an Adventure novel, we’re going to see great settings and a fast pace. In a Thriller we’re going to get violence, and at least one moment when the villain has the hero at their mercy.
We also don’t expect a bear-trap amputation injury in a Cozy Mystery or a Sweet Romance. But we do expect it in the Horror novel.
The point I’m trying to make is that your readers have expectations about what will or won’t happen in your novel, based on the genre you’re writing in. There are always methods available to push the limits, of course, but you can’t go wrong by sticking with what your reader expects – or at least by avoiding stepping too far out of the boundary lines.
A few suggestions…
Fantasy is typically fairly “clean,” in that we don’t see enormous gouts of blood or detailed descriptions of the gristle coming out of the wound. Wounds aren’t horrendous (unless you’re reading George R.R. Martin books). They also tend to be healed with magic rather than naturally, with truncated injury arcs.
Science Fiction likes fancy weapons like blasters and phasers, especially if you’re writing in Military Sci-Fi, but there may be some room for older-school wounds depending on who your hero is fighting. Also, I have never seen a car / scooter / spaceship crash producing significant injuries in a sci-fi story. Again, descriptions tend to be sparse and general; we see the man go down, but we aren’t invited to smell the burning flesh of the wound.
In Romance plots, I would stay away from significant injuries unless they happened prior to the start of the story. There are definitely stories in which nurses fall for their patients, and vice versa, and they’re not wholly made-up; if nurses never fell for their patients, I wouldn’t be alive, because my grandmother cared for my grandfather’s wounds in World War II.
In the softer subgenres of Mysteries, there tend to be murders but not injuries per se.
Action stories seem to think that anything from a bullet to the knee to a love tap with a pistol butt will knock someone unconscious (a trope I despise, by the way), but tend to be light on life-altering injuries. This is, in part, because a great many Action tales don’t have underlying emotional arcs. Think of Indiana Jones: He gets the treasure, loses the treasure, gets the treasure, loses the treasure, meets his ex, gets the girl again, gets the treasure. At no point does Indiana Jones fundamentally change.
Police Procedurals tend to focus on murders, but may be up for a good maiming, especially when an officer gets too close to an investigation and gets hurt. But it’s usually a beating that sidelines the character without a significant change in who they are or how they behave because of it.
The list could go on forever, but the point is this: understand the genre and subgenre you’re writing for so you know what your readers expect. Then deliver on those expectations, making sure that things actually matter.
It’s harder than it sounds, and more crucial than I could ever emphasize.
What’s Your Reality Genre?
There’s a phenomenal book on editing called The Story Grid by Shawn Coyne (and an absolutely epic podcast by the same name). It’s one of the most amazing writing books I’ve ever bought, and it’s worth every penny, and I’m going to borrow an element rather shamelessly from Shawn’s work.
Among other things, Shawn discusses what he calls the Five-Leaf Genre Clover, which is basically his way of categorizing stories. It’s based on structure, on content, and a few other things.
While there are obvious “genres” to do with story type and convention (horror, action/adventure, thriller, coming-of-age, etc.…), these fall under only under one leaf of the Clover, specifically the Content Genre leaf.
I want to talk about a different leaf: the Realism leaf.
Shawn breaks the Realism leaf of the Genre Clover down into four separate categories:
Factualism: These are stories based on things that have actually happened. An injury in a Factual story would be based on what happened and how a person coped. Biographies and historical tales fall into this genre.
Realism: Something that could plausibly happen in our real world. Injuries in the Realism genre need to be strictly accurate: the Inciting Injury is possible; the Treatment, plausible; the Recovery, realistic; the New Normal, what we would expect if it happened to our cousin.
Fantasy: This is Realism with added elements that are not possible in our reality. They can be elves, spaceships, or portable nuclear generators. Injuries in the Fantasy setting can be totally realistic (if the fantastical elements have nothing to do with healing technology or magic). Remember what Arthur C. Clarke said: Sufficiently advanced technology is indistinguishable from magic. Science Fiction is a kind of fantasy in which the fantastical elements are based on real or theorized science, though different subgenres incorporate different levels of realism.
Absurdism: This is a type of world in which an Injury might be treated by filling the character with marshmallows and rolling them up a hill, or a fish might tell your character that to err is divine but to drive to New Mexico is human. Absurdist stories aren’t bound at all by Realistic logic, or at least break that logic deliberately.
Here’s the thing: You need to know which genre you’re writing in. Can you get away with hand-wavy magical healing in your genre? If you’re writing a gritty Realistic war story, probably not. If you’re writing a soft sci-fi (Fantasy) book, probably so. But what about stories in the middle?
For example, if you’re writing an Absurdist piece, go with your imagination: Why shouldn’t the poisonous snake spit healing medfoam that gives your character acid trips but heals their wounds?
Factualism is simply a subset of Realism: it’s based in the real world, and also bounded by history and actual events that took place. The rules of Realism and the rules of Factualism are going to be essentially the same, from this perspective, so we can just roll them into one.
So that leaves us with two functional reality genres left to work in: Realism and Fantasy. We’re going to discuss each of them in detail in the next chapter.
This post is an excerpt from the forthcoming Maim Your Characters, out September 4th, 2017 from Even Keel Press. If you'd like to read a 100-page sample of the book, click here. If you'd like to preorder signed print or digital copies of the book before 9/4/2017, or claim Executive Producer status of the upcoming Blood on the Page, click here.
xoxo, Aunt Scripty
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