What the ‘Golden Girls’ Chronic Illness Episode Means to Me

This essay is part of  Episodes, a monthly column in which senior contributor Valerie Ettenhofer digs into the singular chapters of television that make the medium great. This entry revisits “Sick and Tired,” a groundbreaking episode of The Golden Girls that is especially personal to her.

I’ve been tired ever since I was a kid. The first time I remember my parents worrying about it, I was an elementary schooler with dark circles under my eyes. I had plenty of energy most of the time but was prone to sudden crashes that left me feeling weak and tired. For over a decade, every annual check-up led doctors to pursue the same few options. Since I moved a lot, they often started from scratch, re-checking me for anemia, thyroid problems, or nutrient deficiencies. I saw a therapist in case it was anxiety wearing me out. I saw a cardiologist in case it was my too-fast heartbeat. At some point, my low energy gave way to constant exhaustion. By the time a doctor referred me to a sleep specialist at the age of 26, I’d begun falling asleep driving, writing, and even at work.

In the Season 5 premiere of The Golden Girls, Dorothy (Bea Arthur) faces a medical odyssey of her own. Titled “Sick and Tired,” the episode, a two-parter based on creator Susan Harris’ own experiences, starts with teacher Dorothy explaining the problem that will become the main plot of this storyline. She can’t get rid of the flu she’s had for months. She’s seen two doctors who say she’s fine, but she was physically too tired to speak in front of her class that day.

“Sick and Tired” nails the nebulous emotional pain of undiagnosed and chronic illness from its very first scene. The series is known for its frank dialogue about tough topics, but the episode also includes much subtler exchanges that anyone living with a chronic illness will recognize. Blanche (Rue McClanahan) has decided to write a romance novel, and she imagines a character who is sick like Dorothy, but still beautiful. In her story, she pictures the sick woman being saved by a doctor she’ll fall in love with. Most healthy Americans don’t realize it, but their expectations for healthcare are about as pie-in-the-sky as Blanche’s romanticized vision of illness, especially when contrasted with the draining and traumatic experiences of the chronically ill.

Dorothy goes to see a doctor. She’s uncomfortable in her gown and anxiously awaits her test results, but he doesn’t seem to notice or care. He mixes her chart up with someone else’s then starts dropping hints about a famous patient he’s treating. When he finally gets around to mentioning her bloodwork, he says it’s fine. Dorothy reiterates her symptoms: she has a sore throat, swollen glands, muscle aches, weakness, and exhaustion. The doctor, put off by her insistence and clearly not listening closely, tells her that she’s probably just depressed that she’s single.

This is a moment that, if you’re lucky, will seem completely over the top to you. When I first saw it, it struck me as a stunningly accurate portrayal of the pursuit of diagnosis. While my exhaustion simmered on the back burner for years, I also had a much more urgent health problem to deal with: an excruciating recurrent abdominal pain so severe that it would, among other things, often put me on the floor, curled up and unable to move.

By the time I had unsuccessfully seen a few doctors for this problem, I would enter every exam room anxious, convinced I had to explain every detail of my symptoms swiftly and perfectly or they’d dismiss me entirely. I never had my chart mixed up, but there was a doctor who forgot the diagnosis she’d given me before and tried to re-diagnose me with the same thing when I came for a follow-up. And while nobody told me I was just depressed, a specialist whom I’d been waiting to see for months put me through a rigorous mental health screening after her brusque attitude made me cry from nerves.

Dorothy tries desperately to explain her symptoms in a way that will make this doctor understand her. Clearly, her symptoms have evolved further since the episode’s opening scene, and she’s terrified. She says that some days in the shower, she can’t even work up the energy to reach up and wash her hair. Can you imagine how scary that would be? Arthur’s performance expresses the gravity of the statement. The doctor is dismissive but tells her that she can waste more money checking for another opinion if she wants.

The one saving grace of the scene is Sophia (Estelle Getty), who advocates for Dorothy. “Patient advocacy” is a term that people with chronic illnesses become all too familiar with. Healthcare should be straightforward, but in cases like these, a person has to push. Though she doesn’t change the doctor’s mind, Sophia makes sure to push as much as she can here. He implies that Dorothy’s problem could be mental, and in a close-up, you can see Sophia winding up for a direct verbal hit. “My daughter might be no spring chicken,” she says, before digging into a list of Dorothy’s embarrassing bodily idiosyncrasies. “But one thing she’s not is mental!”

Throughout the two-part episode, Dorothy continues to ask for help and continues to get discouraging and disrespectful responses from professionals. None are worse than that of a specialist she sees in New York. He’s downright belligerent, telling her, “I get tired, too. It’s called getting old.” Dorothy reveals that she’s now had to leave her job because of this illness. The man cuts her off, saying that if she can walk into his office unaided, she’s not sick enough to be there. He implies it’s all in her head, even after she gives him two signed letters from psychologists. She did all her homework, knowing by now that patient care isn’t a right but a battle. Yet she still loses when faced with a bullheaded doctor.

The comments this doctor makes to her as he waves her out the door are downright appalling. He tells her to take a cruise, visit a hypnotist, or change her hair color. He thinks she’s just in a mental rut. Once again, this outlandish conduct hits way too close to home for me. When I first saw a doctor for my pain condition — most likely a disease called endometriosis — he expressed reservations about my fertility. When I asked him if I could have kids, he told me the only way to know was to try. That’s categorically untrue. Also, I was 16 when he said it.

Years later, another doctor told me I probably don’t really have the illness I’d been treated for, which can usually only be diagnosed surgically. Why? Because, she said with authority, if I did have it I would be fatter. As Rose (Betty White) says when Dorothy breaks down in tears after the appointment, doctors don’t know everything. After all, she points out seriously, they let Dr. Suess become a doctor. Rose isn’t the brightest, but I can confirm there are some Dr. Suesses out there.

Throughout “Sick and Tired,” Dorothy’s friends and family take on roles that reflect the lived experiences of chronic illness perfectly. There’s Rose, whose naivety makes her certain that they’ll find a cure with every new doctor they visit. There’s Sophia, who starts to worry seriously about her daughter’s longevity as they approach the five-month mark since they’ve begun seeking a diagnosis. Then there’s Blanche, who minimizes Dorothy’s illness and points out that she never shuts up about it, as if it’s an imposition on her personally.

Living with an undiagnosed or chronic illness is extremely isolating. Every time I have a flare-up, people ask what’s wrong and are surprised when I tell them it’s the same issue as before. Employers lose patience with the same-old-same-old reason for calling in sick, and loved ones who haven’t sat on that crinkly exam room paper can’t seem to wrap their minds around the idea that a person could go undiagnosed or unbelieved for so long. After a while, it seems like people think you’re doing something wrong as a patient, and that you’re somehow keeping yourself from getting cohesive care. If you’re lucky, your loved ones get savvy, helping you navigate the broken system. This happens in the Golden Girls episode when Blanche suggests Dorothy take off her makeup for her appointment so she’ll look more visibly ill. But as often as not, chronically ill folks may feel more like Dorothy does at her lowest point, when she’s burnt out and worried that maybe she truly is crazy.

Dorothy’s story finally starts to turn around in the second half of the two-parter. She sees a family doctor who’s also an old friend, and he’s funny, sweet, and in her corner. He sends her to a virologist who looks at her chart more closely than anyone else has, forming a comprehensive idea of her condition that goes beyond lab tests. This doctor tells her he thinks she has a newly named condition called Chronic Fatigue Syndrome. He explains that many doctors don’t recognize it since they “can’t see it under a microscope.” In the face of a positive medical experience rather than a traumatic one, Dorothy is so overjoyed that she can’t think straight to ask questions.

The best part of “Sick and Tired” is the ending. Dorothy, Blanche, Rose, and Sophia go out to a fancy restaurant, where they order expensive champagne that Sophia later cons the waiter into giving them for free. “What are we celebrating?” he asks. “My daughter found out she has a debilitating disease!” Sophia answers, before Dorothy adds, “And it has a name!” As with so much before it, this moment of unorthodox joy hits home for me. I was unabashedly eager to strap on dozens of wires for the sleep study I finally did 15 years after I first started struggling with exhaustion, and even more elated when it gave me an answer — with a name!

Susan Harris’ deeply personal take on medical trauma and the journey to diagnosis would’ve been a highlight for the sitcom, even without the cherry on top. Yet she wrote Dorothy a moment of catharsis so profound, it brings tears to my eyes each time I watch. In the midst of celebrating, she realizes the doctor from New York is sitting at a table near theirs. Her friends warn her not to make a scene, but she has a gleam of righteous purpose in her eyes. “Order without me,” she says to her friends, and there’s heavy emotion brewing in her voice.

Dorothy’s full monologue is breathtaking, some of Arthur’s sharpest work in the series. She tells the doctor she’s gotten a diagnosis, then remarks that he should check out the CDC’s information about it. He tries to sidle out of the conversation, but she tells him she’s not done talking yet. He can’t cut her off or wave her away this time.

Her dressing down isn’t about making this man feel stupid; it’s about making him feel empathy. She points out his misogyny, his arrogance. She says she wishes every doctor would get sick and scared for a short time early in their career, so they could know what it feels like to desperately need compassionate care. In the end, Dorothy reminds him that sooner or later, everyone needs a doctor. “Someday, Dr. Budd, you’re gonna be on the other side of the table,” Dorothy says as she stands to leave. “And as angry as I am, and as angry as I always will be, I still wish you a better doctor than you were to me.”

The episode ends with one of the series’ most touching triumphs. Because it’s a sitcom, Dorothy never mentions her illness again. I wish that’s how it worked in real life. I have both my pain problem and my sleep disorder under control now, though neither is gone for good. It was a relief to find treatments that worked for me, but it’s not an exaggeration to say that watching “Sick and Tired” for the first time was almost as much of a relief. The Golden Girls made history in a dozen different ways across its run, normalizing aspects of aging and womanhood that no one had ever discussed on TV before. This episode in particular, though, is like a sacred text to me. It’s a guidebook to where I’ve been that I can share with the people who love me and the people who have luckily never been in my shoes.

Roger Ebert famously called movies empathy machines, and of course, if movies are, television is, too. This episode of The Golden Girls is deeply powerful proof of that.