Dr. Thomas Fisher’s memoir, “The Emergency: A Year of Healing and Heartbreak in a Chicago ER,” offers a firsthand critique of the country’s unequal healthcare system.
The Chicago South Side native has been an emergency room doctor at the University of Chicago Medical Center for two decades. Thomas’ vivid account of the early days of Covid-19 is haunting. Caring for his community then was terrifying, he writes, “standing near unmasked COVID patients feels like being in the room with someone holding a gun.”
Fisher’s gripping account of the day-to-day triage in the ER is frustrating. He writes, “doctors like me are often pushed into unbearable struggles with moral and ethical dilemmas that flow from administrative and financial realities that demand concessions in our values.”
The frustration is personal. In his book, Fisher wrote about an experience that deeply influenced him: Fisher was 9 years old when Ben Wilson, the best high school basketball player in the country, was shot. Wilson was taken to a hospital where he waited hours for surgery. The experience stayed with Dr. Fisher because he grew up close to Wilson with a similar background – professional parents and “sheltered from the streets,” and it became the first time Dr. Fisher was touched by violence.
Years later, Fisher wonders whether Wilson would have survived if he had been taken to a better resourced hospital a few blocks away. “My calling is to take care of people like Benji…folks struck by healthcare emergencies in the same community that pushed and shaped me.”
Fisher invites the reader to sit with his reality and what it can tell us about the healthcare system.
“The emergency department is a place where we see this unvarnished truth,” he writes. “Healthcare workers like my colleagues and me care for those whose bodies reveal America’s broken promises.”
This conversation has been edited for length and clarity.
Q. What does the emergency room teach us about the country’s healthcare system?
What’s interesting about the emergency department is that you see the entire cross section of society. It’s the only place in the American healthcare system that’s required to care for everybody, regardless of their ability to pay. The emergency department is a place where you get the best perspective of our bodies. What I’ve learned in 20 years of taking care of sick people is that everyday people come to me sick and injured, not because of anything in particular except that they were just simply trying to live, and the patterns that reveals helps me understand the truth about society and each of our place in it.
The other thing it has taught me is that it is very easy for us as providers – nurses, pharmacists, doctors – to not only become calloused to what we’re seeing, but if we then pause and step back and take a more clear look, it helps to reveal that our patients are trapped not only by a society that hurts and injuries them, but then when they come and get care. They’re again trapped by these same systems, and [we] as providers are trapped right alongside them, trying to do the things that we’ve been trying to do, but unable to do so, based on barriers, many of which I described in the book.
Q. You write about a defining moment in your career in February 2009. You faced an incredibly difficult ethical dilemma as hospital leaders shared a plan that “made it clear that poor neighborhood people are undesirable patients.” The plan called to shutter ICU beds and other beds to make room for special patients or “patients of distinction.” Can you tell us about that experience and why it was so defining?
It was my first job and not only did I have student loans, but I had a world full of optimism. It was soon after “Unequal Treatment” had been published, which was the Institute of Medicines’ document on health Inequities and in the early 2000s they’d already had 30 years of documentation. They had a nice taxonomy that described how these inequities were produced largely where we live, learn, work and play, but also amplified by access. There was a growth in diversity in the trainees so in my naive junior faculty head, it was like, we’ll roll up our sleeves and start to fix this pretty quickly.
Then the housing crash happened that took the economy with it. People lost jobs and their insurance and all of a sudden the job that we had to do, taking care of sick people and getting them the resources that they need became even harder.Things like getting people outpatient follow-up for specialty care or an inpatient bed after being admitted were restricted because health systems responded to fewer people with insurance by restricting the resources available. These are systems, right? Hospitals, clinics, doctors, nurses want to get paid for the services that they provide in a society where healthcare is so expensive that few can pay for it, except for the most wealthy. Most people pay with insurance, either public, Medicare and Medicaid, or private, linked to employment. There are financial incentives to guide all of this. I remember very clearly hearing slogans like: “no margin, no mission.” It’s used to justify trying to make sure that you have enough resources available. It’s really rational except when you realize the mission is people’s bodies.
Q. What are your policy recommendations?
I think it’s important to say that many of the challenges that I think we face require a vast reorganization of society — something that’s intergenerational and requires persistence.
We need a level of leadership that looks a little bit different. So, for example coming down the pipe are incredible, transformative inventions, cures for cancer, therapeutics for sickle cell anemia, solutions for blindness and the challenge will be, each of these innovations will worsen inequality unless we turn our focus away from market based consumption and that’s going to require a generation of leaders who harnessed the creativity, moral clarity and courage to ensure that we prioritize people over profits.
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