A South Side doctor wrote letters to patients to say what he didn’t have time to tell them
Thomas Fisher figured he would end up in the very place he works, in the emergency room. Eventually, everyone passes through. Two springs ago, at the onset of the pandemic, he thought he might die of the thing he was treating in others. He updated his will, removed enough cash from the bank for six months, stocked his refrigerator. He doesn’t own a car so rather than risk contracting the virus in an Uber, he borrowed a car for several months. Then, each day, he drove in for his eighthour shift in the emergency room of the University of Chicago medical center, and he did whatever he could.
The next day, at home, he journaled and journaled.
When we spoke, he insisted, more than once, he was a doctor, not a writer.
And yet his new memoir about 2020, “The Emergency: A Year of Healing and Heartbreak in a Chicago ER,” is one of the year’s best, partly because it is the work of a physician describing, with a natural writer’s concision, craft and bluntness, his vulnerabilities. In harrowing ways, it is an account of a Chicago ER doctor not just saying what he would like to say to patients he treats but asking what he wished he had time to ask. You know doctors — in and out. He knows it, too. His book is about that gap between what he accomplishes and what lodges in his head after he’s gone home.
It is in the long nonfiction tradition of workplace exposes that describe — in prisons, schools, restaurants, or, going back to early 20th-century Chicago, meatpacking plants — the way things work as they actually work, how the pieces of the jigsaw puzzle snap together (or rather, should fit together). Sometimes they’re muckraking; and sometimes they’re about process. Fisher’s
book is more of the latter, with an opening line so haunting and immediate, you’re transported back two years:
“We had been waiting for the virus to appear in our ER, but when it did, a heavy pall still fell on the department.”
The environment, though, often resists best-laid plans.
Fisher is writing partly from a place of frustration, a knowledge of how much better things could be, particularly for Black patients on the South Side. Here and there, pages curdle with revulsion, at how hospitals steer clear of the poor and avoid the very neighborhoods they stand in, but also why wait times turn into eternities, and how, as he writes, “your health care is unresponsive to your needs because organizations fail to make moral decisions when it matters.” “The Emergency” gathers into a furious indictment of not only his own workplace, but American health care, and its interlocking failures and racial inequities, too knotty to untangle.
At least, it can read that way. “The truth is, we can do what we want, if we have the will,” Fisher told me.
Though the flatness of his face suggested that untangling will never end.
Which, like the book itself, paradoxically, leaves you at times with an odd reassurance, that despite endemic problems, some of the people involved are doing their best. And these people, at their most efficient and thoughtful, move with Borg-like sync, in ways Fisher didn’t fully know until the pandemic. He calls this the “flow state — perfect immersion and focus, with no gap between thought and action.”
I witnessed it when I met him the other day.
As I waited for his shift to end, a security guard approached and asked if I was supposed to be there. I gave Fisher’s name and said I was a reporter. He looked skeptical, then returned minutes later. Fisher was extracting himself from a long day, so it took a bit and I lingered. The guard approached a third time. Until finally Fisher emerged and the security guard said, almost to himself, “Good, OK, now that’s done.”
He was doing exactly what he was paid to do. Later, in a hospital cafeteria, Fisher said:
“I don’t think I ever noticed how much the team worked together (until the pandemic). Because every job becomes routine. I took for granted that the nurses, techs, security guards, that they would all be there. And then people started getting sick. Which made me realize, if nothing else, we were in this together, in a way I had not fully embraced.”
And yet ... And yet ...
“The Emergency” never describes a medical system in Chicago that works; nobody would confuse the stress it puts on already stressed, marginalized communities with a healthy system. He describes a hospital that has seemed dissociated at times, going out of its way to avoid the poor. The book makes clear that these problems are not unique to UChicago Medicine or Chicago itself. In a statement to the Tribune, University of Chicago Medicine said it appreciates Fisher for using his book “to highlight the ongoing systemic and structural issues in America’s health care system, including the operational challenges and demands of busy emergency departments serving urban cities such as ours.” They note, as Fisher does himself in the book, that some questionable “initiatives proposed by previous leaders were correctly abandoned more than a decade ago.” They add that Fisher’s ER (expanded in 2017) is now handling 75,000 patients a year; they’ve added Level 1 trauma care; they’ve announced the construction of a new cancer center on the South Side; and they’re “working to strengthen the local health care ecosystem,” partly by helping to establish the South Side Healthy Community Organization. They agree that: “Addressing the ramifications of systemic and structural racism is critically important.”
And yet, reading “The Emergency,” it’s hard to feel optimistic. It’s even harder to come here, to this medical campus against the eastern edge of Washington Park, and not recognize how clinical and removed the space seems against the evocative, gothic streets of Hyde Park. Could be a condo complex, could be a medical complex. Like a lot of big city hospitals, it’s both nowhere and everywhere.
And Fisher wanted to work here — here, as in this ER. He planned on it.
“I grew up a mile away,” he told me. “This is my community. Everyone comes through. People I grew up with, their parents, my teachers. They all come to this place, CEOs and homeless. It makes me think I’m a community doctor. Which is the point of being a doctor. It’s even better because I grew up around here, because I know the context — ‘Oh, this happened on the corner of 83rd and ...’ I know that corner, I know their context.
“ER doctor, as a specialty, gained importance in the 1970s,” he said. “A jack of all trades, master of some. I chose this specific job because an ER was the only place where everybody could be treated, regardless of ability to pay. Which meant a lot to me. How else could I see everyone? I remember a poll in a medical journal that asked the motivation of physicians who seek this type of work, and it’s broad — people interested in self-sufficiency who’ve learned to survive in the wilderness, people who are interested in the acute presentations of critical care. And people like me, social justice-oriented.”
Fisher’s mother is a social worker; his father is a physician. He is trim and serious and focused, with salt-pepper hair that makes it hard to gauge his age; he prefers not to say how old he is, only that he attended nearby Kenwood Academy High School in the 1990s. He wore his aqua scrubs beneath a parka, unzipped to a spring chill. He’s been a health care insurance executive and a White House fellow for the Department of Health and Human Services (where he worked on the HHS Action Plan for Reducing Racial and Ethnic Health Disparities). He attended Dartmouth and Harvard and did his medical training with the University of Chicago (where he has also taught).
“Thomas was always a catch,” said Natalie Moore, a WBEZ journalist who grew up with Fisher (they once appeared in Chicago magazine’s most eligible singles issue, in the same year). “He was smart and going places. We never dated, but we’re alike in ways. I knew I wanted to be a journalist at 13 and serve Chicago. And Thomas, he loved medicine early, and I think there was something about being in this community that just makes you feel like you want to serve it, even if, at 13, you don’t put it like that.
“I think what he wants most is for people to understand the structural problems behind health care.” In fact, she credits him with conceiving the shape of a group project she did for WBEZ in 2020 on how the pandemic was disproportionately impacting certain Chicago communities. For what would become the widely praised public radio series “50 Lives in 4 ZIP Codes,” Fisher suggested they select their subjects by neighborhood.
In his forward to “The Emergency,” celebrated essayist Ta-Nehisi Coates describes the evening about 17 years ago when he met Fisher at Moore’s apartment in Bronzeville. They were talking shop and eating and having fun, until police lights appeared in the window. There was the body of a young man outside, surrounded by police tape.
Coates never forgot the image but knew it was different for Fisher.
Coates writes: “It was not merely that Tom was an ER doctor directly caring for those affected by the plague of gun violence that covered the country and levied a particular toll on Black neighborhoods ... He was caring for the lives and bodies of his neighbors. I don’t think it’s too much to say that the lion’s share of Tom’s professional life has been consumed not only by treating the kind of violence we bore witness to that evening, but by an urgent attempt to understand why that violence tends to fall with such weight on the South Sides of America while barely grazing its Gold Coasts.”
Fisher said, despite his instincts, Coates pushed him to think of himself not as a doctor who writes but as a writer. He had been keeping a journal for years, as a way to study scenarios and deal with the frustration and terrible things that he would see in the ER.
He had the material.
The day we met he had just finished an eight-hour shift. He saw old people with chest pains, middle-aged people with “questionable heart failure,” young people with infections, intoxicated people and some who may have had strokes. All in all, extremely typical.
Though watch the ER and you can see how confusing and fraught this gets. The elderly couple leaning on each other as they move through automatic doors to the front desk, and the son pushing a mother in a wheelchair, one leg looking painfully inflated. The woman who stands at the window scanning for her ride, and the man slouched in a seat watching March Madness while unable to sit comfortably for more than a few seconds at a time. In his memoir, Fisher writes of summer 2020 as a frantic convergence of COVID patients and activists straggling in after violent confrontations and the human toll of gun violence and formerly jailed prisoners falling back into old drug habits, though without the tolerance now.
“But it’s always the same,” he said. “One person is sick, and the other (the doctor) is not. It’s the big day that a lot could change for one person, and for the other person, they get some coffee and go home. Yet there is a spark of humanity. American health care has ignored or abstracted that, yet both sides of that relationship, they still crave it.”
So “The Emergency” alternates diaristic chapters with the letters Fisher would have liked to have written to a handful of patients and colleagues (for privacy, scrubbed of real names and recognizable details), to better explain why things are the way they are.
To Janet: “I held your leg, ordered your pain medication, and stood between you and your mother.” He writes that they come from the same place, with the same childhood trips to the Field Museum, and the same overpolicing, violence; he’s still affected by the 1984 shooting of Ben Wilson in Chatham, then the best high school basketball prospect in the nation.
To Dania: “We worked together in your first week as a doctor.” He recounts the financial and corporate reasoning within the health care system that leads to their ongoing stasis.
To Robert: “You came to me swollen because of your kidney problems.” He describes the cascade of inequities and chronic conditions that proliferate across the South Side.
Fisher wrote the letters, he said, from a sense of, “if you could know not just the context you and I exist in, or this hospital, but neighborhood, city, you would understand what is happening is not only not your fault, and a lot of it you can’t control, but you’re a piece in this societal puzzle and until we change it, then someone will take your place tomorrow.”
By the end of his book, the next someone is his mother.
He knew, by working in the neighborhood where he grew up, in the place where his parents still live, he might eventually arrive at this point. His mother’s side hurts, she has trouble sleeping. He calls ahead to his department and tells them his mother is coming.
“I felt ambivalent about that,” he told me, “but I didn’t want my mom caught in the shape machinery of this system that sometimes hurts people, which I have seen happen. I have presided! Nor do I want to push other well-deserving people aside to get something for myself. But I am also a son. I wanted to be the worried family member.”
In the end, it hardly matters. Her care at his own hospital is not great.
Furious, he writes to executives at UChicago Medicine (a letter published in full in the book), seeking “a reckoning,” “a strategic reorientation” of the ER. He told me that he didn’t make “challenging claims about this specific institution. We are all part of a health care system that we all hope to reform.” But “I’m also not naive to think transformative change would happen because of one person.” On the other hand, “when a VIP gets a workaround, we need those people advocating for better systems.”
And nothing changes, at least not in the span of this book.
“But that is also one version of the truth,” he said, “there are many versions. Mine comes from 20 years of covering sick people in an ER on the South Side of Chicago.”