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Here is the latest in a series of examinations into urban legends about TV and whether they are true or false. Click here to view an archive of the TV urban legends featured so far.

TV URBAN LEGEND: Julianna Margulies’ character, Carol Hathaway, basically died in the first episode of ER.

TV shows have long had a tradition of writing characters off in early episodes and then quickly changing their minds when early audiences responded well to the character. Hill Street Blues famously re-shot two early episodes (including the pilot) when they decided to bring two characters back from the dead (Officer Renko in the pilot and Officer Coffey at the end of the first season). In the case of Julianna Marguelies’ Carol Hathaway on the plot of ER, though, the change amusingly happened after they left the first episode the same, meaning that they left the first episode as it was originally written, including the fact that Carol effectively died in the episode!

We meet Carol Hathaway, County General’s nurse manager, early in the two-hour pilot of ER, titled “24 Hours” (since the whole first episode takes place in, yes, you guessed it, 24 hours). She is clearly competent and well liked and she also is shown to have had a past with roguish doctor, Doug Ross (George Clooney).

She leaves work near the halfway point of the episode…

However, right before she leaves, we see her get something from the drug cabinet (to which she had the keys)….

We don’t think anything of it, of course, until about mid-way through the episode when Carol shows up as a PATIENT! She has overdosed!

Here’s the thing, though. Originally, Carol was going to die in the episode. As a result, the various tests that they ran on Carol were such that she effectively was dead. Here is a brilliant summation of the situation by Lindsay E. Murphy:

Carol’s prognosis in the Pilot is so dismal because of two things mentioned: her serum barbiturate level and her positive Babinski reflex. In the first case, a “serum barb” is part of a tox screening that measures the amount of barbiturates (a potent class of central nervous system depressants/sedatives) in the patient’s bloodstream. Depending on the specific drug she took, the serum concentration of barbiturate needed for a fatal dose can range from anywhere between 30 and 80 mcg/mL; Carol’s was 45 mcg/mL, which should have been more than enough to kill her.
Second, the positive Babinski. Barbiturates work by inhibiting activity in the nervous system; consequently the CNS slows down, which makes barbiturates a very handy class of drugs for controlling seizures and sedating hyperactive patients. Overdose, however, causes a “shutdown” situation in the CNS, leading to coma, respiratory arrest, and death as the brainstem (the segment of the CNS that controls autonomic functions such as respiration and heartbeat) shuts down. One test used in neurology to see how badly the CNS is damaged is the Babinski reflex; stroking an object (the end of a reflex hammer, a blade, your finger, whatever) along the outside sole of the foot should cause the foot to flex inward (plantar flexion); this is a negative Babinski, and suggests intact motor function. In a positive Babinski, the toes, most notably the big toe, dorsiflex (splay outward); this is a sign of severe motor deficit, and is usually (though not always) associated with diffuse cerebral damage.

This last point also refers to Morganstern’s comment. Decerebration, or the loss of cerebral functions, is the complete shutdown of the cerebrum, that portion of the brain that controls all higher functions – senses, thinking, memory, etc. If the cerebellum and hindbrain (or brainstem) are intact, the patient will retain autonomic function and remain in a coma; if these structures are damaged as well, there will be no respiration or heartbeat save for that artificially maintained by a ventilator and/or pacer, and the patient is said to be brain-dead.

Given her barb level and lack of CNS response, Carol should have died. A few patients have been known to survive high doses of barbiturates – the chances of this happening, however, do fall into miracle territory.

However, test audiences liked Carol so much that the show decided to have her survive, but without changing the rest of the episode! Kevin Reilly, NBC’s VP of Drama at the time, noted that they looped in a line about her maybe surviving, but that must have been in reruns, because it’s not in the original pilot.

Carol, though, survived and showed up alive in the next episode. It reminds me a lot of how 77 Sunset Strip’s pilot ended with Edd Byrnes’ Kookie headed to the electric chair but audiences liked him so much that they retconned the first episode at the start of the second episode and Kookie became a good guy.

The legend is…

STATUS: True

Thanks to Lindsay for the excellent information!

Be sure to check out my archive of TV Legends Revealed for more urban legends about the world of TV.

Feel free (heck, I implore you!) to write in with your suggestions for future installments! My e-mail address is bcronin@legendsrevealed.com.