Nurse Jackie began in 2009 as an original, fascinating show about a nurse addicted to oxycontin, created by Liz Brixius, Linda Wallem, and Evan Dunsky. Dunsky left the team after the second year of the seven season show, but Brixius and Wallem, who were a couple off-screen, continued to be partnered showrunners until the beginning of the fourth season. When they ran into off-screen personal difficulties that affected the show, they lost control of the series and were superseded by Clyde Phillips as executive producer until the series’ demise in 2015. The story of what happened to Nurse Jackie when Phillips took over is a tale of an unfortunate sex change. Nurse Jackie was and remained a formulaic sitcom, in that it conformed to the venerable TV industry practices of linear narrative, forward motion, clarity. and conclusiveness. But when Brixius and Wallem were in charge, originally, despite the myopic complaints of the New York State Nurse’s Association about the series’ insult to the character of nurses, Nurse Jackie achieved a picante blend of formulaic structural clarity and characters depicted with moral and psychological complexity. When Phillips took control, Nurse Jackie took a turn toward the simplistic—and the sexist.

Female protagonists of formulaic series’ are either good, a hero, or bad, an anti-hero. Sure we might be offered a funny pragmatist with a few arch twists of character, like Selina Meyer (Julia Louis Dreyfus) in Veep (2012–), but in its first three years Nurse Jackie, while maintaining the overall pace and crispness of formulaic TV, genuinely pushed the envelope. Veep is sardonic; a witty, dry, detached, sometimes cutting but ultimately pro-forma look at the contradictions of political life. However, Jackie was authentically engaged in the mystery of human personality under modern pressures, not the stuff of which formulaic protagonists like Selina are made.

Jackie Peyton (Edie Falco) was, originally, a truly liminal figure. Jackie, an ER nurse at the fictional All Saints Hospital, was addicted to painkillers because of her bad back. As an addict, she was a liar, a cheater, and a betrayer of her most intimate relationships. But she was also uncompromisingly honest as a nurse with a strict understanding of her duty of care, and affectionately devoted to her handsome, loving, stable husband, Kevin Peyton (Dominic Fumusa), and her two daughters Grace (Ruby Jenns) and Fiona (Daisy Tahan). Everything about her blurred the rigid character boundaries that are the hallmark of formula TV. At the same time she was simultaneously having regular sex with the hospital pharmacist, Eddie Walzer (Paul Schulze), for reasons that could never be reduced to easy generalization. Certainly, Jackie wanted to ensure that she had a steady supply of drugs, but maybe she enjoyed the extra pleasure. (Ans what to make of a woman who wants extra pleasure?) Radiating the feel of inscrutable life, Jackie was fragmented, impossible to resolve to a type around whom we could draw a line.

Until the beginning of the fourth season, sometimes shocking the audience with her capacity for callousness and lies, sometimes stunning us with her determination to go far beyond the call to save a life; Jackie stood as an enigma who paralleled on a micro level the macro level combination of duplicity and idealism of the broken medical system she served and the country she lived in. In the fourth season, Clyde Phillips began to restructure Jackie and the show to fit neatly into a box marked, as Phillips put it, “There is a price to be paid.” With a heavy hand on the tiller, as showrunner, Phillips made the show an open and shut case for Jackie as sinner. Was it a coincidence that when a man was put in charge of the show, Jackie degenerated into a clearly culpable person who deserved death for her irregularities?

Well, ultimately yes, but the problem was this man, not all men. We know there are many creative men in television who are highly complex about depicting the way people “reap what they sow,” the most stellar being David Lynch, David Chase, David Simon, and Matt Weiner. I contend that Nurse Jackie is illustrative of what happens to a show with a fresh and original point of view—in this case an atypical feminist perspective–when it leaves the stewardship of the original creators, particularly when they have an organic approach to writing, and the new management is capably mechanical and formulaic–in addition to being sexist.

In the case of Nurse Jackie there was an enormous difference between what Brixius, Wallam, and Evan Dunsky began with and what Phillips put in place. Brixius, Dunsky, and Wallem were certainly not without concern for the consequences of Jackie’s twisted behavior, but they worked consciously to, in Wallem’s words, “nurture the narrative” and let things develop. They had it in mind to let things pay off organically, but Phillips came in with the determination to make things pay off, to force every situation to its extreme. Brixius, Dunsky, and Wallem originally created a universe of indeterminate enigmas; Phillips, in so many words, believed he was making “improvements” on the series by turning it into something approaching a medical procedural, a universe with hard, clean edges, rigidly designed resolution, and hard and fast judgements. Hard not to conclude that there are gender issues here. Some might say that there was in this change of administrations a transition from what is classically understood as maternal order (“nurturing’) to what is classically defined as paternal authority (domination).

In those initial seasons, Jackie had a fully humanized female protagonist, marked by defects, failings, and slippage, a feminism contemporary actresses outspokenly long for, the freedom to have flaws. Jackie also had strength and guts, engaged as she was in a guerilla war against the intractable power of modern economics that has reduced spirituality to statues of the Christ, Mary, and a few Catholic saints at All Saints Hospital. It wasn’t until the fifth season that Phillips appeared in the credits as executive producer and Brixius and Wallem were suddenly listed as consulting (not executive) producers, but his debilitating influence was already shaping up in the fourth season. When the administration of a television series changes, the new influence is often felt long before it is officially noted in the credits. When I was fired from a soap opera as story editor, my name appeared onscreen until the end of my contract. It’s a Writer’s Guild rule. That’s why Brixius and Wallem didn’t seem to be gone when they actually were, despite their technical presence as “consulting producers.” Clearly, however, by the fourth season, when he became the de facto showrunner, the tone, approach to narrative structure, and perspective of Brixius and Wallem were on their way out.

When Clyde Phillips took charge of the series, in an unhappy development, the series was forced back into the mold of conventional narrative, and the women were newly objectified. One visual sign of the suddden, conventional objectification of Jackie and her sidekick nurse trainee Zoey (Merritt Wever) was manifest in their sudden glamorization with traditional studio make-up, in contrast to the first three years in which they had had real women’s faces. New characters were added who were die cut to the specifications of cliched stereotypes. The original characters were either sent away or chopped and changed to suit the clear outcomes and resolutions that Phillips, by his own word, believes is part of good television writing.

Some detailed contrast and comparison between the Pilot and the series finale will hopefully add some compelling concreteness to this analysis. The Pilot begins with nothing more—and nothing less—than a woman trying to do her job under impossible circumstances. The exposition of Jackie’s situation is highly original. The screen is a blaze of white light, punctuated by the scream of a siren and failing life support. Slowly the visual resolves to an image of a Jackie lying on a hospital bathroom floor. On the soundtrack is the theme from Valley of the Dolls (Dir. Mark Robson, 1967), a movie about three women in the entertainment industry who become drug addicts as a result of thrill seeking and the pressures of fame. The contrast with Jackie is ironic.

Jackie is a Catholic working class woman who needs to earn a living and, as the old advertising slogan goes, she hasn’t got time for the pain of her bad back Her Catholicism is emphasized in her voiceover which interrupts the theme from the overheated 1960’s melodrama. Her parochial school education at the hands of Sister Jane Deshuntel, whom Jackie considers a “smart fucking nun,” has acquainted her with “The Lovesong of J. Alfred Prufrock,” written by T. S. Eliot, who, a nice nuance for this show, converted to Catholicism as he aged. Whether a viewer knows this or not, a mood is created when Jackie recites the first line of Eliot’s poem in her voiceover: “Let us go then you and I, when the evening is spread out against the sky like a patient etherized upon a table.” Jackie is spread out against the bathroom floor, narcotized. However, she isn’t going anywhere. She is a sea of liminality. But it isn’t purely Jackie’s pathology; it is also a cultural pathology. Jackie is addicted to painkillers to keep up with the economic and professional demands on her. The world she lives in is a mass of contradictions. There is no blaming the victim.

Jackie’s mind is filled with conflicting impulses, poetry remembered, financial pressure, and her religious upbringing. The “smarting fucking nun” has taught Jackie that people with the most capacity for good also have the most capacity for evil. We begin in a place where the sacred meets the profane, where the sublimity of poetry mingles with the basic bodily needs, where crude common sense merges with philosophical speculation. Jackie peels herself off the floor to go into action as a nurse when a badly hurt young bicycle messenger is brought into her trauma unit, and we see that Jackie’s external life is also a rich mix of elements: service, hard work, expertise grown of experience, frustration at the hands of a hospital hierarchy both self-serving and bureaucratic, determination to force a crazy world to make sense and contain a modicum of justice, and also Jackie’s sexual excesses and drug addiction.

Jackie is working in the trauma unit of the hospital, a position filled with figurative as well as concrete implications for her situation. Her world is one big trauma. The very young bike messenger dies because of the problems inherent in the chain of authority in the unit. The doctor of record, Dr. Cooper, in his fatuous egocentrism, does not listen to Jackie and overlooks a fatal internal bleed that she intuits and of which she warns him. Around one turn of the hospital corridors, the head nurse of the trauma unit, Gloria Akalaitis (Anna Deveare Smith), stalks Jackie with bureaucratic concerns; around another bend of the corridors Jackie is charged with mentoring the irrepressible Zoey. A badly slashed, very bloody prostitute is wheeled into the unit, suffering terrible pain, as is the Libyan diplomat who slashed her, but who has diplomatic immunity. The same cannot be said for the girl, who cut off the diplomat’s ear in the melee. The diplomat need not account for his predatory sadism; she is blamed for defending herself. Jackie’s day is rounded out by a boy high on drugs is wheeled into the unit who has put a fire cracker into his anus and set it off to see what would happen, and then the pregnant girlfriend of the dead bike messenger wanders in not knowing what to do since she has no means of support for herself and her baby.

The introduction to the series invokes a continuing series of crises for which there are for the most part no easy melioristic solutions. A young boy, whom Jackie could not save, is dead; his baby at risk. A sex worker is horribly maimed with impunity by a coldly arrogant sadist who both insists that she wanted that kind of attention, and propositions Jackie as she is attempting to professionally administer medical treatment. A kid’s curiosity, twisted into self-abuse by drugs, has resulted in extreme physical scarring. Jackie’s only big success in the Pilot is at the restaurant when she is on her lunch break, when she administers a heimlich maneuver to a choking woman. Unlike the medical procedural, the episode is not about heroic medical measures that snatch the afflicted from the jaws of pain and death. Here death assumes its appropriate power over official medical intervention. Jackie knows she can only take the unnofficial route, and take it she does. She forges a living will that turn the dead messenger into an organ donor, in order to give the meaningless death some dignity and value. She flushes the severed ear of the diplomat down the toilet so that he too will be scarred by his actions, and taking his money from his pocket, clearly a substantial amount in an expensive money clip, Jackie deposits it into the purse of the bike messenger’s pregnant, destitute girlfriend, as she lies sleeping on a bench under a stature of Mary. Jackie is a criminal whom it is hard to blame. Only her borderline, sleazy relationship infidelity with hospital pharmacist Eddie (Paul schulze) careens close to the edge of our patience with her deviance—once the last moments of the Pilot reveal her home situation for the first time.

The initial intent to create Jackie as a character about whom easy judgments are impossible is made manifest through visual images when an extended close up of an oil painting in the hospital chapel of Judith holding the head of John the Baptist is juxtaposed to the mad confusion of Jackie’s day. The image poses silent questions about the line between courage and maliciousness, good and evil. The implicit, ancient commentary of a complex, inscrutable image of the world made by religion in all its ambiguities—hardly the simplistic moralism of religion as it is usually presented in pop culture sanitized priests and nuns—is encapsulated in Jackie’s closing words in the pilot, when she thinks about St. Augustine, who decided not to lead a virtuous life until he had his fill of pleasure. Jackie wants to do likewise, and, using Augustine’s words, she asks God to make her good—but not yet. As she thinks these words, we see her coming home, where she greets her unsuspecting husband, stepping not into light as she returns to her family, but into shadow.

The Pilot predicts accurately the nuanced, compelling, fresh originality of the tenure of Brixius and Wallem and contrasts radically with Phillips’ episodes. By the time of the series finale, “I Say a Little Prayer,” season 7, Ep 12, Phillips has hopelessly compromised Jackie as a character and her context has been reduced to a standard pop culture caricature. When the Phillips run regime created the series finale, it bookended it with the Pilot seeking harmonious closure, but de facto putting a point to how much it had destroyed the originality and quaulity of the series. To Phillips’ credit, he gives abundant evidence that he has studied how the series began and that he intended to close the circle with many references as possible to where it all started. But he is able to reference only externals, with, arguably, little concept of the difference between the paradoxes, characteristic of the earlier Brixius/Wallem regime, and inconsistency, the hallmark of his; nor does he have an inkling of what a difference it is to see women from the outside and from the inside.

The series finale begins in a church, Jackie kneeling and praying, “Make me good,” reprising her plea to Augustine in the Pilot, but without the “not yet.” This comes as Jackie, in previous season seven episodes, has made herself clean and sober, regained her nursing license after a strict review of her drug taking, and then began popping pills at a frantic rate once she was officially in the clear. It also comes just as she has arrived at a good place with her older daughter, Grace, with whom she has been struggling for almost seven seasons. Similarly, now divorced from Kevin, she is in a good romantic relationship with pharmacist Eddie, who adores her, and although she is watching All Saints close because of the Norwegian developers, she has hope of being hired by Bellevue, an important New York hospital. But Phillips is determined that Jackie will pay the price with her doom.

Her reversion to drugs immediately after her license is safe is forced onto the character. We all know that addicts are devious. So might run the defense of the decision that put her back on pain killers without missing a beat once her license was granted. However, because there is absolutely no interior struggle before she resumes her drugs, despite the fact that she is becoming close to Grace, which has been one of her most consuming desires throughout the seven years, and that by committing suicide she is going to ruin her younger daughter’s confirmation ceremony, many would agree that there is a certain capriciousness, incompatible with the foundation of the character.

When Jackie downs a pill immediately after her prayer to be made good—and omitting “not yet”– it’s hard not to ask whether this is the compulsion of the addict, or the compulsion of a formulaic storyteller? This feels like the collapse of a show that once separated itself from sexist cliches into torrent of anti-woman dramatization. What’s more, where the social context of American medicine in all its frustrating, ineffable complexity was originally what Jackie was up against, Phillips had with his tenure brought in a good old fashioned villain, reductively concentrated in an easy-to-hate form, a bad hospital corporation. Quantum Bay, a stereotypical inhumane medical corporation, took over All Saints as a convenient target for audience anger and hatred. When bad formula writing occurs, the defense is always, “Well this could happen,” and that covers everything but sprouting wings. The responding question that is rarely asked in the world of formula TV is “but could it happen in this fictional universe?” it’s a case of jumping the shark by reason of change in administration. Much of what Phillips put onscreen couldn’t have happened in the original series; and some of it couldn’t/didn’t happen anywhere. Moreover, can someone remind me again how Quantum Bay is the price to be paid for Jackie’s bad behavior? And how is it another consequence for Jackie that Quantum Bay then sells the building to an even more formulaically villainous Norwegian real estate developers which entirely closes All Saints to turn the hospital building into a collection of high rise, luxury condos?

There are some moments of excellent craft during the Phillips regime, but most of the time craft descends to narrative trickery devoted to formulaic clarity and a resolution in which Jackie pays for being a woman drug addict and sexually promiscuous. It feels more than a tad suspicious despite the “high road” claims Phillips made for his decision. Some may be tempted to wonder why in the medical procedural series House, which also deals with a protagonist overly dependent on oxycontin for his pain, House (Hugh Laurie) does not need to be punished, nor does his dependency have to be pushed to extremes as Phillips pushed Jackie’s drug problem, since the moral core of the country did not collapse as a result. Phillips’ changes smack of the stereotypical attitude toward women which demands that we be disciplined more heavily for infractions than male protagonists tend to be, and which characterizes us in terms of the danger and destruction that our sexuality purportedly threatens. This is not to evaluate Nurse Jackie in terms of the statistically documented realities about whether addicts can or cannot be cured. Many cannot, as Jackie is not, but that’s not what’s wrong with the turn taken by the series in season four that propelled it to its manipulative final episode.

Phillips himself would protest that he went out of his way to be complex because it is impossible to say in the last shot whether Jackie has died for her sins or not, and because he rounded out the series with Zoey saying, ‘you’re good, Jackie, you’re good,” as she tries to revive her from her final (?) drug coma. A formulaic writer would point to that degraded version of the ineffable end of The Sopranos with pride. And used with truth and skill, obviously, an indeterminate ending could be a reason to be proud. But here it’s all so mechanical, mostly because Phillips destroyed Jackie’s character so systematically that it doesn’t really matter if she lives or dies. Phillips himself has spoken of his decision to make the ending “ambiguous” because he wanted it to be unexpected and so controversial that it would be much talked about. He is clearly oblivious to his showboating as the essence of the inferior, tricky approach to formula writing.

The hollow, manipulative quality of the end of Jackie is underlined by the unusual sterility of two choices made by finale episode director Abe Sylvia when he misused very well known techniques of interiority to convey Jackie’s final (?) moments. After Jackie inhales three lines of coke as the series is being brought to a close at a farewell party for the staff of the closing All Saints Hospital, we see from her perspective an internal fantasy and then we see Zoey from Jackie’s point of view when she comes out of the fantasy. As Jackie is physically collapsing in the outer world, she hallucinates a walk on a sunny 42nd Street and Broadway among crowds of people, and she joins a group of folks who are doing yoga at this famous intersection. When the audience point of view becomes external and we watch Jackie’s colleagues trying to revive her, there is a POV shot of Zoey’s face that can only be Jackie’s as Zoe says, “You’re good Jackie; you’re good,” followed by an external shot of Jackie, wide-eyed and possibly dead. Jackie’s hallucination and her focus on Zoey should have drawn us into Jackie’s interior experience as did the beautiful choices made by Allen Coulter, who directed the Pilot episode, invoking a blinding light clearly from within Jackie, as a representation of the (blessed?) bliss of relief from pain killers. But the effect of Sylvia’s choices is just the opposite. One would be hard pressed to find another example of an interior fantasy and a character point of view that actually distance the audience rather than connecting it with the character’s interior life. The once high flying (in every sense) Jackie is degraded to the status of pitiful object.

Was anyone in the cast or production crew aware of the fall of Nurse Jackie? Hard to believe that either show’s creators Wallem, Brixius, and Dunsky (if he was still paying attention) or Edie Falco, a brilliantly intuitive actress, didn’t notice. However, the way entertainment journalism is practiced, there were no questions asked that facilitated expression of their possible reservations, disappointments, or even anger. This leaves only serious students of the media to assert that this tree fell in the forest.

Martha P. Nochimson is currently teaching for The David Lynch Graduate School of Cinematic Arts. She is the author of seven books, including No End to Her: Soap Opera and the Female Subject; David Lynch Swerves: Uncertainty From Lost Highway to Inland Empire; and the editor of The Wiley-Blackwell Companion to Wong Kar-Wai. This essay is based on the research she did for her newly completed ninth book, Art Versus the Business of Storytelling: The Battle for the Future of Television, to be published in 2019, a study of the major changes that have taken place in series TV since the appearance in 1990 of David Lynch’s Twin Peaks.