An ER memoir conveys hectic work, empathy and outrage
By Dwight Garner
Thomas Fisher’s memoir, “The Emergency,” is about being an emergency room doctor on Chicago’s South Side; it’s a busy book about a busy man.
The doors open, and in they flow: mostly poor patients with grease burns, heart failure, broken bones, unexplained bleeding, STDs, ectopic pregnancies, feet rotting from diabetes, untreated mental illness, head wounds, bullet holes.
Fisher has three minutes, on average, to spend with each hurting person, before passing them along or sending them home. He makes quick decisions; observing him is like observing an elite basketball team’s starting point guard, with the clock always ticking.
This book reminds us how permanently interesting our bodies are, especially when they go wrong. Fisher’s account of his days is gripping. While reading, we are all, helplessly, medical voyeurs.
Local newspapers print police blotters; they should print short summaries of emergency room visits, in unfiltered detail, with names redacted. That would be a public service. We might learn something, and our own woes would be put into context.
Fisher’s writing about his stream of patients is what gives this memoir its immediacy, its pulse. “The beauty of emergency medicine,” he writes, “is the way an entire team can enter a flow state — perfect immersion and focus with no gap between thought and action.”
His book derives its depth and tone from his arguments about the inequities of American health care. Fisher is moved, and infuriated, that so many African Americans die young because they lack access to decent insurance and treatment.
His frustration, his outraged intelligence, is palpable on every page of “The Emergency.” Fisher grew up on the South Side; his father was a doctor. He knows how much better the care is across town, in white areas. He dilates on the roots of Black poverty, about the war on drugs and predatory lending.
He is Orwell-like on the euphemisms that hospitals employ to turn away the poor in favor of fewer, wealthier patients. One is “We will shrink to distinction.” Another: “Restricting resources will improve flow.” They make him want to retch.
Someone once suggested that politicians should wear sponsor jackets, like NASCAR drivers, so we know who owns them. Fisher feels similarly about rapacious health care executives.
In the emergency room at his own hospital, the University of Chicago Medical Center, where he has worked for the past 20 years, wait times can reach six hours. Once patients make it to a private room, the waiting doesn’t always end. Fisher recounts the times frustrated people, with jobs to attend to and lives to lead, have simply walked out, “with their blood pressure cuff, gown and beeping monitor left behind.”
He is not ripping the mask from emergency room care, the way Anthony Bourdain exposed food prep in “Kitchen Confidential.” He’s proud of his work, of his hospital, of medical advances, even if he does go home every night feeling, psychologically, burned to a crisp.
Fisher works out his aggravation by writing letters to some of his patients, explaining why he couldn’t spend more time with them and why the health care system is so dismal for so many. These are long letters, and they appear in this book.
I’m sorry to report that they don’t work, not really. The letters are a conceit, and they feel artificial, like exposition-filled movie dialogue.
Fisher remains a somewhat distant figure in “The Emergency.” He skips quickly through his own biography: childhood, Dartmouth (where he felt isolated as a Black man), medical school, time in academia, work as a health-insurance executive and as a White House fellow during Barack Obama’s first term.
He’s more than impressive, and I’d have read a lot more about all of that. His fond list of the Black businesses his parents patronized during his youth, and the Black-owned brands they sought out, is a high point.
We don’t learn a lot about his private life now, either the small, earthy details or the things that seem to genuinely matter. What Fisher does provide is the best account I’ve read about working in a busy hospital during COVID. He takes us back to the early, scary days, when almost everything was unknown and, as he writes, “every cough is like a bomb going off.” His hospital readied its negative pressure rooms, left over from Ebola scares.
He expected to become infected himself, and he feared passing COVID along to his parents and others. He told loved ones he couldn’t see them, and he lived alone, not going out except for work. He writes: “I prepared my affairs — set up autopay for my mortgage, stocked my freezer and withdrew cash as though I’d be gone for six months. My will was up-to-date.”
Maybe beauty, poet Lucia Perillo wrote, “is medicine quivering on the spoon.” Fisher locates beauty in a different part of the medical process. The most eloquent sections of “The Emergency” might be those in which he mourns his inability to spend more than a moment with people in distress. “Patients with a doctor are said to be in the act of being seen,” he writes. He has no time to see them properly. People need to tell their stories, he writes, and to have a doctor with the time to listen.