It’s grist for the trysts

Change is hard, as Meredith Grey has observed more than once in the signature voice-over of “Grey’s Anatomy.” After the show’s strange slide into bathos last season, everyone involved, including show runner Shonda Rhimes and pinup star Patrick Dempsey, acknowledged a certain creative downturn, a gloomy earnestness, that would, they swore, be rectified. “We’re bringing the fun back,” Rhimes said. Indeed, the first episode of Season 4 was entitled “A Change Is Gonna Come.” And millions of fans breathlessly waited . . .

And waited. Eight episodes in, things have happened of course. George (T.R. Knight) told new wife Callie (Sara Ramirez) that he cheated on her, so that marriage is over and George is officially in love with former best friend Izzie (Katherine Heigl), though if the fans have anything to say about it, that won’t last long either. The suddenly single Callie moved in with the suddenly jilted Cristina (Sandra Oh). Derek (Dempsey) and Meredith (Ellen Pompeo) continue their dance of longing and leaving.

But the only real change is that Isaiah Washington is still gone, and the fabulous Brooke Smith, playing Dr. Erica Hahn, has taken his place. Hahn is a terrific character, sassy and professional, with an appropriately acerbic view of the various romantic shenanigans. She also seems to be a carefully considered stand-in for viewers choking on the soapy silt of last season, a way for the writers to move forward without messing with the hugely successful brand. (Don’t get too nervous, Brooke, but the future of TV’s once highest-rated drama may be in your hands.)

Changing a big hit television show is a tricky business. It’s easier to tinker, though often not as effective. And while “Grey’s” remains a big hit, its ratings continue to slide; a few weeks ago, they hit an all-time low.

At Fox, on the other hand, the creators of “House” have gone with a bolder approach -- bringing in a whole new set of ancillary characters to cure the increasingly myopic focus on the lead (Hugh Laurie, looking increasingly haggard) -- with more satisfying results. Likewise “Nip/Tuck,” on FX, decided to forego the Botox and give itself the big midlife lift. But the writers of all three shows have apparently remembered that the only thing people like to talk about more than their love lives is their ailments.

In other words, while viewers like the romance and character development, they need to have their medical shows rooted in, well, medicine.

Rich veins to mine

Doctors, cops and lawyers dominate network TV for a reason. Their jobs, by their very nature, provide the exact ingredients of a successful TV show: smart, professional main characters; a high turnover of interesting ancillary characters (patients, clients, criminals, etc.) and, of course, that life-or-death tension that eludes most of us keyboard-rattling, cellphone-wielding Normal Folk, and lifts the characters of “Grey’s” or “Boston Legal” or “Women’s Murder Club” out of neurotic schlepperhood and into dra-mah.

Watching lovely people tango with lust while they perform heart surgery or an odd couple find a friendship while they track down serial killers provides not only emotional frisson but audience connection to a rarefied world. We may not know how to surgically disconnect conjoined twins, but most of us have known the frustration of thwarted love and betrayal.

What made “Grey’s Anatomy” so successful in the first place was its creation of prickly yet still sympathetic characters, people you might actually know, who were then put in an extraordinary circumstance -- the first year of residency at a high-pressure hospital. There was friendship, but there was competition; there were bad decisions and panic, but lives were saved and careers begun.

The problems of last season, which have unfortunately trickled into this season, were not about losing sight of the fun, but of the medicine -- the dramatic possibilities of medicine. These are doctors, with all manner of flaws and frailties, yes, but still doctors. Which is why they have their own TV series. (And writers strike notwithstanding, “Grey’s,” “House” and “Nip/Tuck” are good for at least another month of viewing.)

Cleaning ‘House’

The second season of “House” was even more successful than the first, but it was clear that the increasingly intense focus on the foibles of Gregory House (Laurie) and his strained relations with his team was limiting the show. Having run out of things for House to “battle” (authority, Vicodin dependency, his ex-wife, his team, the cops), the writers decided to start all over again. Literally. At the end of last season, Drs. Foreman, Cameron and Chase had either quit or been fired. This season opened with House vainly attempting to go it alone. After hilariously turning to a janitor for help, House, rather than weeding through job applicants, accepts them all. Then he eliminates most of them as if he were the medical Heidi Klum of “Project Runway.” (He hasn’t said auf Wiedersehen yet, but odds are, he will.)

What seemed like shtick turned out to be a brilliant move. The original team is still around with different duties, but half a dozen new people have brought in new stories, new ways of dealing with patients and new psyches for House to explore with his Holmesian insight and his venomous tongue. Whether or not the changes are permanent, the show has been broadened in ways it could not have been had the old format been left in place.

Likewise, “Nip/Tuck” dragged itself out of a self-involved rut by hauling Drs. McNamara and Troy from the sultry madness of Miami to the City of Angels. This gave the creators not just a great billboard image (fallen angel with wings cut off -- yikes) but also a whole new playpen to roll around in, not to mention a legitimate call for main character development. Suddenly Sean and Christian (Dylan Walsh and Julian McMahon) are not the local hotshots; in L.A., they’re just old new kids on the block. Christian, especially, comes slap up against his age and how much his appearance informs his self-esteem (oh, the irony).

But the stroke of brilliance was “Hearts & Scalpels,” the show within the show. By having Sean become a consultant/star of a hit medical show, “Nip/Tuck” creator Ryan Murphy and his writers can take on the whole genre with either a sledgehammer or a scalpel, depending on their mood. Using tips he picked up from a dominatrix, Sean persuades the young stud star of “Hearts & Scalpels” to at least try to mimic surgical techniques and, overnight, the show’s ratings skyrocket. “It’s all about the surgery,” he says in amazement to Sean, his new mentor.

Yes, yes it is. Because while much of “Nip/Tuck” plays its sick games with the psychological issues revolving around cosmetic surgery and the people who perform it, it also offers a stomach-turning look behind the scenes of the actual procedures. Which, admit it “Nip/Tuck” fans, is half the fun.

One could argue that “Grey’s” too was reborn, in the form of “Private Practice,” and that it’s simply too much to expect the established hit to totally revamp at the same time a spinoff is making its debut. “Private Practice” had a rocky beginning (its devastatingly silly pilot involved, among other things, a fight over a dead man’s sperm and a Caesarean performed with neither anesthesia nor appropriate surgical equipment) but seems to have found calmer, if not terribly deep, waters since.

Though the action takes place in a “wellness center” as opposed to a hospital, the cases have been medically interesting and believable enough to anchor the sophomoric romantic subplots. “Grey’s” has always been limited medically by its focus on surgeons; in “Private Practice,” the writers can use fertility issues, drinking problems, child abuse -- anything to keep things interesting.

A lot of smushy love stuff was siphoned off “Grey’s,” mixed with a dash of frisky-risky sex talk, and injected into “Private Practice,” which seems to be aiming for more of a “Sex and the City” demographic than its progenitor. Which is fine. Smushy love stuff and sex talk ain’t bad, as long as they’re counteracted with righteous medical cases.

Consider, for a moment, that “ER,” which created the modern model of the medical drama, with all its surgical sturm and emotional drang, still marches on having cycled through several generations of cast members and their personal issues. It may not be the fresh, innovative show it once was, but 300 episodes and 13 years on the air? That my friends, is the power of a well-tended IV.

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mary.mcnamara@latimes.com