An ER Memoir conveys hectic work, empathy and outrage

A Year of Healing and Heartbreak in a Chicago ER
By Thomas Fisher
254 pages. A world. $27.

Thomas Fisher’s memoir, ‘The Emergency’, is about being an emergency room doctor on Chicago’s South Side; it is a busy book about a busy man.

The doors open and they pour in: mostly poor patients with fat burning, heart failure, broken bones, unexplained bleeding, STDs, ectopic pregnancies, rotting feet from diabetes, untreated mental illness, head wounds, bullet holes.

Fisher has an average of three minutes to spend with each injured person before passing them on or sending them home. He makes quick decisions; watching him is like watching the start watch of an elite basketball team, while the clock is always ticking.

This book reminds us how lastingly interesting our bodies are, especially when things go wrong. Fisher’s account of his days is poignant. While reading, we are all, helpless, medical voyeurs.

Local newspapers print police blotters; they should print brief summaries of emergency room visits, in unfiltered detail, with edited names. Which would be a public service. We could learn something, and our own misery would be put into context.

Fisher’s writing about his flood of patients gives this memoir its immediacy, its heartbeat. “The beauty of emergency medicine,” he writes, “is the way an entire team can get into a state of flow — perfect immersion and focus with no gap between thinking and acting.”

His book takes its depth and tone from his arguments about the inequalities of American health care. Fisher is shocked and furious that so many African Americans are dying young because they don’t have access to decent insurance and treatment.

His frustration, his outraged intelligence, can be felt on every page of ‘The Emergency’. Fisher grew up on the South Side; his father was a doctor. He knows how much better care is on the other side of town, in the white areas. He takes a closer look at the roots of black poverty, the war on drugs and predatory lending.

He resembles Orwell on the euphemisms hospitals use to reject the poor in favor of fewer, wealthier patients. One is, “We will shy away from distinction.” Another: “Limiting resources will improve traffic flow.” They make him want to gag.

Someone once suggested that politicians should wear sponsor jackets, like NASCAR drivers, so we know who they belong to. Fisher feels the same way about predatory healthcare executives.

At 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 be as much as six hours. Once patients reach a private room, the wait doesn’t always end. Fisher recounts the time when frustrated people, with jobs to care for and lives to lead, simply walked away, “with blood pressure cuffs, gowns, and monitors beeping left behind.”

He’s not tearing the emergency room mask, as Anthony Bourdain exposed food preparation in “Kitchen Confidential.” He is proud of his job, of his hospital, of medical progress, even though he goes home every night feeling psychologically down to the bone.

Credit…Jeff Sciortino

Fisher resolves his annoyance by writing letters to some of his patients, explaining why he couldn’t spend more time with them, and why health care is so bad for so many. These are long letters, and they appear in this book.

Sorry to report that they don’t work; not really. The letters are cocky and feel artificial, like a film dialogue full of expositions.

Fisher remains a somewhat distant figure in ‘The Emergency’. He quickly flips through his own biography: childhood, Dartmouth (where he felt isolated as a black man), medical education, time in academia, work as a health insurance manager, and as a White House employee during Barack Obama’s first term in office.

It is more than impressive, and I had read a lot more about that. His treasured list of the black companies his parents frequented during his childhood, and the black brands they sought, is a highlight.

We don’t learn much about his private life now, nor the small, earthly details or the things that seem to really matter. What Fisher does offer is the best report 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 prepared the rooms for negative pressure, left over from Ebola fear.

He expected to become infected himself and was afraid of passing Covid on to his parents and others. He told his loved ones that he could not see them and that he lived alone and did not go out except for work. He writes: ‘I prepared my business – arranged autopay for my mortgage, stocked my freezer and took out cash as if I were going to be away for six months. My will was up to date.”

Perhaps beauty, wrote the poet Lucia Perillo, is ‘medicine that vibrates in the spoon’. Fisher places beauty in another part of the medical process. Perhaps the most eloquent parts of “The Emergency” are those in which he mourns his inability to spend more than a moment with those in need. “Patients with a doctor would be in the act” seen,” he writes. He doesn’t have time to see them properly. People need to tell their stories, he writes, and have a doctor who has the time to listen.

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