The October 24 episode, Shonda Rhimes and Marti Noxon's "In Which Addison Finds a Showerhead" (11.7 million viewers), is notable for a minor plotline built around Dell's first pap smears--and for revealing to viewers for the first time that he is in fact a nurse. Dell has some aptitude, despite his early jitters and mixed reactions to the "boy nurse" working in "lady town." But on the whole the episode presents Dell as a nurse--presumably with a BSN, since he attends midwifery school--without significant skill or experience with patients. An early scene finds Addison announcing Dell's new venture at a staff meeting. Addison: Let me mention quickly that Dell is doing his first solo pap smear today, we should all be proud... There is some clapping, cheering and hooting. Dell looks sheepish but pleased. Dell: It's just a pap smear, it's no big deal. Cooper: Don't choke man, I know it might seem dark and scary down there-- Naomi: Do not mock the midwife. Next order of business... This is priceless. In fact, the show has done little but "mock the midwife," and this scene is another example. Yes, it purports to suggest that Dell will be learning an actual health care skill and his physician surrogate parents should be "proud." But the execution suggests that this skill is relatively trivial, and (again) that midwifery students get their training by physician grace, rather than primarily from midwives in graduate programs. So we assume this is either just an inside joke--the show creators know very well that every episode "mocks the midwife"--or an odd, subconscious blurting of the show's true, harmful approach, even if the creators are not fully aware of it. The show proceeds to show Dell performing three pap smears, apparently over the course of a week. Before the first, a nervous Dell wonders if Addison wants to be present. She advises him to ask if the patient wants a female chaperone, and to relax, since patients can smell fear. Dell, being just a nurse, would not know that. She also tells him to keep the speculum warm, to tell the patient what he will do before does it, and to introduce himself--"doctors always forget that." Dell: I aced bedside manner. I'm gonna give a happy pap, no worries. Ick. And we're on to Dell's first pap. He enters the patient's room, smiling, and wearing his surfer boy t-shirt. The patient is abrupt and impatient. The nervous Dell fumbles with the speculum--and drops it. Patient: He just dropped the thing. Dell: OK, that happens. He holds it up, as if to show it's fine and can be used. Patient (pointing): You're not going to use that. Dell: No, a new one, I'm getting a new one. But it doesn't seem very credible. Dell, the nurse, apparently did not know that a speculum dropped on the floor would not be clean or sterile and should not be used. The scene also illustrates Hollywood's flawed presentation of anti-nurse bias. The show does not actually endorse the patient's "boy nurse" comment--we're supposed to find the comment out of line--but the show doesn't do much to rebut what underlies the comment either. Maybe the patient's mean to say it, but there is something kooky about being a boy nurse. Plus, you can be a nurse while you're still a boy because really, there's not much too it. The scene ends with Dell softly muttering that it's "not a happy pap, not a happy pap." For the second pap, Dell is too cute. Naomi takes over. Dell and Naomi arrive for the third pap. This patient, who is older, is hostile from the first sight of Dell. She says she won't have "a child" poking around in "lady town." Dell assures her he's not a child, but she is not persuaded. Dell has had enough. Dell: Your loss. ... You know, Beethoven composed his first symphony when he was five. Five. Picasso mastered the human form at seven. This is what I was born to do, and finally I'm doing it. I would have rocked this pap smear, I guarantee you'd never receive a more respectful, complete examination of "lady town" in your life. So, yeah, your loss. Naomi looks impressed. And the patient consents. This is the first and only thing that looks like clinical expertise from Dell in the first five episodes of "Private Practice." Of course, Beethoven wrote his first symphony when he was nearly 30. Maybe the writers mean Mozart, who apparently did write a symphony at roughly age eight, but really, who can tell those two apart? You get the point. Somebody was precocious, just like somebody teaches midwives, somebody provides the important patient care, and so on. Near the end, Dell thanks Addison for an "awesome week of gynergy." Addison: Dell, you cannot say "gynergy" if you want to work with me. Dell: Hey, I've got an idea--I'll only say "gynergy" when I hear the word "midwif." OK, we just made up Dell's last line. In fact Dell, undeterred by Addison's reaction, just says "got it" and leaves.