The Emergency: A Year of Healing and Heartbreak in a Chicago ER

“will give health policy makers much to consider about ways to improve care. Fisher’s own take is that key principles must guide reform: centering humanity at every juncture, elevating moral leaders, and addressing justice with systemic solutions.”

In an unmailed letter to a poor elderly woman, emergency room doctor Thomas Fisher expresses his frustration in treating patients from his native South Side of Chicago. “You came to me short of breath, and you were still laboring when you departed to take care of your grandkids,” he writes. “Your heart failure came after a long and rocky COVID course. We didn’t offer you much help for your heart failure or your family situation.”

In fact, he goes on, “it must all look ridiculous to you, health care that doesn’t really care, a system designed by people in nice offices who, try as they might, fail to make it better.

“I want to tell you why I failed.”

Fisher’s The Emergency—an absorbing narrative of the year 2020 in the ER of the University of Chicago Medical Center—is interspersed with many such letters, filled with things Fisher might have said if he had had time. Amid the frantic ER pace, he can spend just a few minutes with each patient. He hardly gets to know them.

“These people have waited hours to see me. People queue as though they’re waiting to meet an oracle, and then we disappoint them with the banality of the process. I wonder if to them I’m no different than the fraudulent wizard Dorothy finds in Oz.”

Fisher is a Black man in his late 40s. A Dartmouth graduate with a medical degree from the University of Chicago and a master’s in public health from Harvard, he is a highly qualified doctor hampered by the stifling bureaucracy of a major American medical center.

“Eight years of training, nearing twenty years of experience, and all I have [to offer] is Tylenol, apologies, and a handshake,” he writes.

He grew up in a professional family in Hyde Park, an integrated neighborhood near the University of Chicago. His father is a doctor, his mother a retired social worker. Both parents came of age in the Jim Crow South. They taught him to give back to his community.

And so Fisher, a former White House Fellow honored as one of Crain’s Chicago Business’s 40 Under 40, works in an ER where many patients—disadvantaged by race, income, or insurance status—experience poor health outcomes.

The Emergency tells their wrenching stories. (Ironically, few stories involve the COVID pandemic, which kept many patients out of the ER, making care giving more efficient.)

As ER supervisor, Fisher worries about all of the patients. He tries to elevate the status of a woman with life-threatening kidney failure. She has been waiting five hours to see a doctor. But all beds are full, and she may not be the sickest person in the waiting room. “That gap between what we need to do for truly sick people and what we can do because of resource constraint is one of the deepest frustrations I face.”

Another patient, an 18-year-old badly beaten at school, is also waiting. So is a toothless 50-year-old man who keeps himself high on “embalming fluid” (the hallucinogenic drug PCP): “It puts your mind somewhere pleasant,” he says while flirting with a nurse and cracking jokes. Then there is the woman with the painful right hand: “The smell coming from it Is the smell of rot, of death.”

Fisher’s deep commitment to these patients is evident. Each story becomes a window on the terrible inability of even his major medical facility to promptly and efficiently provide needed care.

The reader may wonder why he doesn’t move on to another big-city hospital. Similar situations exist in all of their ERs, he writes. His intimate accounts of what goes on at Chicago will alarm anyone about the terrible state of America’s emergency medical care.

“Black people, who densely populate the South Side, are forced to endure a gauntlet of health risks: jobs that maim, food that sickens, air that chokes, and guns that kill. This would be a simple story of winners and losers, except there is no competition—not a fair one, at least. The contest was decided at birth.”

On a day when Fisher is not at work, his own mother comes to the ER with a life-threatening pulmonary embolism. She leaves the hospital misdiagnosed, untreated, and still in pain. She finds treatment elsewhere.

In an unsent letter to her, Fisher writes: “You were simply a Black woman on the South Side, treated as so many women on the South Side are handled—the ER was too crowded, your caregivers too distracted, your suffering abstract.”

His book will give health policy makers much to consider about ways to improve care. Fisher’s own take is that key principles must guide reform: centering humanity at every juncture, elevating moral leaders, and addressing justice with systemic solutions.

With a foreword by Ta-Nehisi Coates, The Emergency is a moving, well-written account of American ER care and the disadvantaged that demands wide attention.