SGEM Xtra: Career Advice from Buffy the Vampire Slayer

Dr. Amy Bi is a graduate from the SSM Health Saint Louis University Emergency Medicine residency and the University of Missouri School of Medicine. She is interested in continuing medical education, orange theory, and travelling.

Career Advice from Buffy the Vampire Slayer

1. Honour Your Calling

• Quote: “You talk about slaying like it’s a job, it’s not. It’s who you are”. What’s My Line? Part 2; S2, ep 10. Writer: Marti Noxon

Our path in medicine is somewhat different than the “one girl in all the world” who is destined to fight the forces of darkness, but there are analogies. Buffy sometimes struggles with her calling but ultimately accepts her path (Prophecy Girl). And she shows that this is not a single event, but something she chooses every day (What’s My Line, Anne, Amends). We come to medicine with our own set of strengths and skills, choose our path, and actively reaffirm it as we complete years of education and residency training. There are certainly challenges in our healthcare system, but there is also connection and sometimes even joy.

2. Meeting Challenges

• Quote: “Bottom line is, even if you see ’em coming, you’re not ready for the big moments. No one asks for their life to change, not really. But it does. So, what are we, helpless? Puppets? No. The big moments are gonna come. You can’t help that. It’s what you do afterwards that counts. That’s when you find out who you are.” Becoming, part 1; S2, ep 22. Writer: Joss Whedon
• Quote: “From now on, we won’t just face our worst fears, we will seek them out. There’s only one thing in this world more powerful than evil, and that’s us.” Bring on the Night; S7, ep 10. Writer: Marti Noxon with Douglas Petrie

Medical school, residency, and even attending life are filled with learning from students, residents, coworkers, nurses, colleagues, and administrators. We must incorporate new evidence into our practice, learn from mistakes, and improve for future encounters. New situations come at us all the time; it’s how we strategize and confront them that counts. That might mean reading up on disease presentations we do not see often or practicing high-acuity, low-occurrence procedures. Knowing we are prepared for the challenges we see can give us confidence.

3. Work-Life Balance and Leaning into your Humanity

• Quote: “It’s the 90s, the 1990s in point of fact. I can do both. Clark Kent has a job, I just want to go on a date… If the apocalypse comes, beep me.” Never Kill a Boy on the First Date; S1, ep 5. Writer: Rob Des Hotel & Dean Batali
• Quote: “You know how you’re always trying to save, oh, every single person in the world? Did it ever occur to you, you are one of them?” You’re Welcome. Angel S5, ep 12. Writer: Joss Whedon, David Greenwalt, David Fury

One theme in the early seasons of BtVS is the tension between Buffy’s duties as a Slayer and her desire to have a normal life. This sometimes goes awry, as her efforts to continue her normal high school activities find her hexed (Witch), rendered helpless by a cursed Halloween costume (Halloween), and almost eaten by a lizard demon (Reptile Boy). But eventually, she finds a path that provides her a stable-ish home life and meaningful friendships while being a Slayer.

In season five, Buffy cuts herself off from her emotions, worrying that the burdens of being the slayer are turning her to stone. To be successful and avoid burnout, we must process the sorrows we encounter and lean into the joy. We often make tough choices without full information, doing the best we can with less-than-optimal situations. Sometimes we can offer reassurance that a patient’s symptoms are not dangerous, sometimes we must tell patients or families about an impending death, sometimes the best we can offer is a comforting presence and minimizing suffering. We must offer ourselves the same grace we give so freely to others.

4. Challenging Dogma

• Quote: “I appreciate your thoughts on the matter, in fact I encourage you to always challenge me when you feel it’s appropriate. You should never be cowed by authority. Except, of course, in this instance, when I am clearly right and you are clearly wrong.” I Only Have Eyes for You; S2, ep 19. Writer: Marti Noxon

Much of what we do in EM is not well-grounded in the medical evidence, but it is important to seek out new evidence and stay current in the literature. And acknowledge things that are tradition or “dogma” rather than evidence-based. Some of us will even choose to contribute to expanding that evidence base! But it is crucial to be a critical reader of the literature even if research “isn’t your thing”.

This is especially important to me as an attending – I ask our senior residents to teach me something every shift – sometimes from an article they read, a podcast I haven’t listened to, or a new technique with ultrasound.

5. Being a Girl and A Badass

•  Quote: “Yes, date, and shop, and hang out, and go to school, and save the world from unspeakable demons. You know, I want to do girly stuff”. Faith, Hope and Trick; S3, ep 3. Writer: David Greenwalt
• Quote: “Did we not put the “grr” in girl? Living Conditions,S4, ep2. Writer: Marti Noxon

Replace “demons” with “diseases,” and you have a pretty good mission statement for Women in Medicine. Buffy starts the show as a stereotypical high school girl, more interested in clothes and popularity than academics or saving the world. As she grows into her role, she incorporates her fashion sense into the job, patrolling in her favourite orange tank top and her “stylish yet affordable” boots. She is physically strong, but never feels the need to suppress her feminine side to fulfill her duties as Slayer. Likewise, we can be our authentic selves and show our personality while fulfilling our professional roles – wear those colourful scrubs or your favourite rhinestone barrette on duty.

Final thoughts about what you learned from the TV series Buffy the Vampire Slayer

Seeking Mentorship and Asking for Help

•  Quote: “Sometimes the most adult thing you can do is ask for help when you need it.” Grave, S6, ep 22. Writer: David Fury

The mentor/ surrogate father relationship between Buffy and her Watcher, Mr. Giles is one of the best-developed relationships in the show. Mr. Giles loses his position in the Watchers Council over his affection for his charge. Several new Watchers are sent, but Buffy leaves the Council when it proves unwilling to support her objectives. After some months without a formal mentor, Buffy again asks Giles to be her Watcher. Even after she completes her formal training, she recognizes her need for mentorship and seeks out Mr. Giles’ help.

In the final season of the show, Buffy becomes a mentor, responsible for all the potential Slayers who have not yet been called. She tries to train them, but early on, they lack the strength and the focus needed to take on the role. In the series finale, she finds a way to share her power with the Potentials, building an army to defeat evil. 

Finding Your Team – The Power of Friendship

It cannot be summarized into a single quote from the show, as it happens so many times that a one-liner doesn’t capture the theme, but…

Buffy’s friends are known as the Scoobies, and each of them plays an important role in her mission. This is called out by one of the villains as a reason that Buffy has lasted longer in the role of Slayer than most. As Buffy draws strength from her friends, our relationships with our families, friends and coworkers can help us through rough times. Women in EM must lift each other, sharing resources, collaborating on scholarly activity, and even socializing, which can remind us that we don’t have to do it alone.

Criticisms/Controversies

Though celebrated for its feminist themes, the show has also been critiqued for embodying a narrow brand of feminism. Issues include:

• Costume choices catering to the male gaze
• Outdated jokes and stigmas (e.g., gay panic, slut-shaming, fat-phobia)
• Toxic behaviours that go unaddressed

I justify my belief that Buffy is a feminist text by going back to the principles of feminist bioethics: Buffy struggles when her duties violate her concept of the good. Her desire is always to protect the vulnerable. She does not seek to punish past wrongdoing as much as prevent future attacks. She gains strength through her community and, given the opportunity, chooses to share her power. Her world has not achieved equity and inclusion, but she pursues this goal in the end.

Another difficult issue is the flawed behaviour of the show’s creator. Like evaluating unethical research, we ask: Do the actions of one person taint the entire product? Should we separate the art from the artist?

Years later, it came out that the experience of the actors and crew on the set of the show did not meet the ideal we might expect from a show that championed girl power and making the tough choices that ground a meaningful life. Many people chose to disengage from the fandom based on the actions of this one person involved with the show.

There are analogies in how we deal with unethical research. When does one “bad” person or a series of choices negate the entire project? Do ethical violations inherently taint the results, or is it possible to find some useful information? How can we best honour the contributions of those who suffered the violations?

I choose to continue to engage with this text. Despite the flaws of its creator, hundreds of actors, writers, composers, set dressers, stunt people, cinematographers, costume designers, and others contributed to the final product and deserve to have their work and their sacrifices acknowledged.

The SGEM will return next week with a structured critical appraisal of a recent publication.  We shall continue in our effort to cut the knowledge translation window down from over ten years to less than one year using the power of social media. Our ultimate goal is for patients to get the best care, based on the best evidence.

Remember to be skeptical of anything you learn, even if you heard it on the Skeptics’ Guide to Emergency Medicine.