“We can’t allow our feelings to dictate the standard of care that we give people.”

Reproductive Healthcare on TV: “Shades of Gray” (ER, 1998)

This post is part of my Reproductive Health, Rights, and Justice project examining the portrayal of reproductive healthcare on television. I am a social scientist, not a medical provider.

Content Notes: This post contains discussion of medical trauma, domestic terrorism, and death.

“Shades of Gray” is an episode explicitly about the abortion debate and a clear attempt to portray its nuances. I mean, it’s titled Shades of Gray; they’re not hiding anything. It’s not a case of bothsidesism. The medical providers, the series they inhabit, and this episode are pro-choice. The anti-abortion protesters are violent and manipulative, and preserving the mother’s choice is a component of each storyline. But for how in-your-face the whole thing is, there is a thoughtfulness.

The Episode

ER Episode 4.19 “Shades of Gray”
Premiered: April 23, 1998

The Plot

Anti-abortionists bomb a women’s healthcare clinic, resulting in multiple patients ending up in the ER.

The Patients

  • Zoe (Sally Levi), a pregnant teen at the end of her second trimester, and her boyfriend Donny (Judd Trichter), who accompanied her to every clinic visit
  • Brianna (Renee Faia), a woman getting an abortion eighteen weeks into her pregnancy
  • Ms. Martinez (Anne Bettancourt), an anti-abortionist protester
  • A woman in her late forties (Christine Rose) at the clinic for an abortion after a surprise pregnancy

The Physicians

Zoe is treated by ER pediatric fellow Dr. Doug Ross (George Clooney). Brianna is treated by ER resident Dr. Anna Del Amico (Maria Bello) and ER attending Dr. Kerry Weaver (Laura Innes). Del Amico also treats Ms. Martinez. And the older pregnant woman is treated by head nurse Carol Hathaway (Julianna Margulies).

The Outcomes

Injured in the explosion, Zoe develops a blood clot that renders her brain dead. However, the fetus is fine and close to viability. The family is given the option to deliver the baby very prematurely or leave Zoe on life support until the baby is full-term. Donny, the baby’s father, wants to give his baby her best chance, but Zoe’s father doesn’t want her body used as a vessel and claims Donny has no rights because he and Zoe are minors. Ultimately, Zoe’s parents choose to continue the pregnancy but refuse to include Donny and plan to take full custody of his baby.

Brianna comes into the ER unconscious, and Anna initially believes she is a prenatal patient due to her later pregnancy (18-19 weeks). Instead, her chart provided by the clinic indicates that she was there for an evacuation. Kerry notes that the procedure was incomplete, and they have to continue it, but Anna finds herself unable to do it. Kerry performs the abortion.

Ms. Martinez considers herself a peaceful protester and is upset about the bombing. While being treated, Martinez shares “peaceful” “pro-life” rhetoric, such as comparing doctors who provide abortions to Nazis and carrying a sandwich board sign with streaks of fake(?) blood that calls abortion genocide. Martinez tries to recruit Anna into her coalition, and when Anna refuses, she passive-aggressively leaves the pamphlets behind anyway. Anna points out that none of her actions are peaceful, and they probably inspired the bomber’s violence.

Carol’s patient doesn’t want her husband to know she was at the clinic. They have four children, now all adults, and he worked past retirement to pay for their college tuition. She says he wouldn’t have the heart to choose abortion, but she knows it’s the best choice for them. Carol helps her keep the secret.Subscribed

The Problems

Viability

There is no test to determine fetal viability. Any delivery before 37 weeks is considered premature, and the trajectory of survival goes down significantly starting with deliveries before 25 weeks. These ‘extremely pre-term’ babies are also at high risk for disability. Zoe’s pregnancy is described as being at “six months, more or less,” which translates to around 24 weeks. Zoe’s parents are given three choices. Remove Zoe from the respirator and end her pregnancy, deliver the baby by emergency c-section, and then remove Zoe from the respirator, or keep Zoe on the respirator to allow the baby to grow and deliver as close to full-term as possible. Doug is a pediatrician, not an OB-GYN, and he prioritizes the baby and the desires of the teen parents, who are also his patients. In this case, with the fetus so close to the threshold for likely viability, Doug’s and Donny’s decisions to push for retaining life support seem appropriate, and the parents coming around to agree suggests it’s the ‘right choice,’ at least according to the episode.

Brianna’s pregnancy is described as being at “eighteen or nineteen weeks” (her medical chart states eighteen weeks). Anna balks at performing the abortion because she believes that an 18-week-old fetus is potentially viable. According to The American College of Obstetrics and Gynocoloy (ACOG) and the Society for Maternal–Fetal Medicine’s Obstetric Care Consensus #6, Periviable birth, “deliveries before 23 weeks have a 5–6% survival rate and significant morbidity is universal (98–100%) among the rare survivors”. Meaning Anna, and the show, is stretching reality.

At that same link, the ACOG makes their position very clear: “Policy making around viability interferes in the patient–physician relationship. ACOG strongly opposes legislation or regulation of the clinical definition of viability.” If it’s hard for doctors who specialize in pregnancy to make these determinations, it’s absurd and harmful for politicians to try.

Choice

We later learn that Brianna has had multiple abortions and delayed this one because she believed her partner, Earl, would want the baby. Kerry counsels Brianna to use birth control, which is appropriate, and calls her irresponsible, which is less so. Brianna is short with both Anna and Kerry, and the story is far more sympathetic to Zoe and Donny, Carol’s patient, and Anna than it is to her. But Brianna’s story is where all the shades of gray appear.

Zoe’s story is a tragedy. Not because she got pregnant at sixteen. Zoe and Donny are a contrast to Brianna and Earl. Textually, given that Doug describes Donny as responsible, and while Earl “hit the roof when he found out,” Donny wants to take care of both Zoe and the baby. Zoe’s story is a tragedy because she chose to continue her pregnancy and have her baby, and the anti-abortionists killed her anyway. And the parents who may or may not be abusive (Donny suggests they were, but it’s not portrayed on screen), but were definitely not supportive, will raise her baby without Donny, whom Zoe loved.

Carol’s patient and her husband lived their lives the ‘right way’ by anti-abortion and pro-natalist guidelines. They raised four children. Now, her choice is a shade of gray, but less so than Brianna’s. Any pregnancy over the age of thirty-five is considered geriatric and at higher risk for complications and/or birth defects. The husband is already past retirement age. Everything about the pregnancy, birth, and the baby’s childhood would be difficult. The people that Ms. Martinez represents don’t care about the nuances. But the series does, and it portrays this patient’s choice in a sympathetic and positive light.

Brianna is different. Brianna is mean and flippant, difficult and unlikable. Brianna is textually irresponsible and is suggested to be abusing the availability of abortion. But I study trauma, and everything about Brianna reads as a trauma response to me. She’s angry, skittish, and reactive. She is not proud of or happy about her abortion. She does not even appear to be relieved. It’s my interpretation that Brianna didn’t want an abortion. She wanted a baby, and she wanted Earl to want the baby. She also doesn’t use birth control because Earl wouldn’t like condoms and pills make her fat. This tells me that Brianna’s whole identity is wrapped up in pleasing others. In living up to an imaginary standard set by an abusive partner and a society that tells women their only worth is beauty and babies. Brianna chooses abortion because she doesn’t see any other choice.

Our stories mirror our reality.

The episode aired 25 years after Roe v. Wade, six years after Planned Parenthood v. Casey, and 24 years before Dobbs v. Jackson Women’s Health. Illinois is a pro-choice state. In Chicago, pregnant people have the fundamental right to reproductive choice regardless of age, gender identity, gender expression, sexual orientation, sexual behavior, class, immigration status, race, ethnicity, language ability, or disability status, and do not lose that right even when in State custody, control, or supervision including in jail, prison or under DCFS custody. Despite the Dobbs decision, the women in this episode of ER would be able to make the same decisions today as they did in 1998.

However, in Georgia, a woman who was nine weeks pregnant when she was declared brain-dead is being kept artificially alive against the family’s wishes to preserve her fetus. One could compare Zoe’s fictional and Adriana’s real story and see similarities, but they are superficial at best. Zoe was close enough to term that they could have delivered; Adriana was close to a point where some people don’t even realize they are pregnant. Zoe’s boyfriend and parents wanted to continue the pregnancy; Adriana’s family is horrified by the state’s decision. Zoe is a fake teen who fake died on a TV show almost thirty years ago; Adriana is a real woman who really died, tragically and too young, who is being used as a vessel for a baby who is mostly likely to need significant care for their whole life and that the State will completely abandon after birth.

And beside Brianna is Anna, who thinks of herself as pro-choice and a feminist, but who freezes up when presented with a woman outside the boundaries of what Anna thinks of as acceptable. ‘Late term’ abortions, at or after 21 weeks, make up only 1% of all abortions, and they are most often sought due to a fetal abnormality or to preserve the life of the mother. Brianna would not fit the definition of late term because, as said above, an 18-week fetus is not viable, but it is later in a pregnancy than is typical, and earlier abortions are safer abortions. However, as barriers to care increase, it takes longer. ProPublica recently documented that “when a state law is unclear and punitive, how an institution interprets it can make all the difference for patients.” Brianna arrives at the ER unconscious with a partially performed abortion. There is a version of Anna’s decision that results in Brianna’s death.

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