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The Emergency: A Year of Healing and Heartbreak in a Chicago ER
The riveting, pulse-pounding story of a year in the life of an emergency room doctor trying to steer his patients and colleagues through a crushing pandemic and a violent summer, amidst a healthcare system that seems determined to leave them behind
ONE OF NEWSWEEK'S MOST ANTICIPATED BOOKS OF 2022
As an emergency room doctor working on the rapid evaluation unit, Dr. Thomas Fisher has about three minutes to spend with the patients who come into the South Side of Chicago ward where he works before directing them to the next stage of their care. Bleeding: three minutes. Untreated wound that becomes life-threatening: three minutes. Kidney failure: three minutes. He examines his patients inside and out, touches their bodies, comforts and consoles them, and holds their hands on what is often the worst day of their lives. Like them, he grew up on the South Side; this is his community and he grinds day in and day out to heal them.
Through twenty years of clinical practice, time as a White House fellow, and work as a healthcare entrepreneur, Dr. Fisher has seen firsthand how our country's healthcare system can reflect the worst of society: treating the poor as expendable in order to provide top-notch care to a few. In The Emergency, Fisher brings us through his shift, as he works with limited time and resources to treat incoming patients. And when he goes home, he remains haunted by what he sees throughout his day. The brutal wait times, the disconnect between hospital executives and policymakers and the people they're supposed to serve, and the inaccessible solutions that could help his patients. To cope with the relentless onslaught exacerbated by the pandemic, Fisher begins writing letters to patients and colleagues-letters he will never send-explaining it all to them as best he can.
As fast-paced as an ER shift, The Emergency has all the elements that make doctors' stories so compelling-the high stakes, the fascinating science and practice of medicine, the deep and fraught interactions between patients and doctors, the persistent contemplation of mortality. And, with the rare dual perspective of somebody who also has his hands deep in policy work, Fisher connects these human stories to the sometimes-cruel machinery of care. Beautifully written, vulnerable and deeply empathetic, The Emergency is a call for reform that offers a fresh vision of health care as a foundation of social justice.
ONE OF NEWSWEEK'S MOST ANTICIPATED BOOKS OF 2022
As an emergency room doctor working on the rapid evaluation unit, Dr. Thomas Fisher has about three minutes to spend with the patients who come into the South Side of Chicago ward where he works before directing them to the next stage of their care. Bleeding: three minutes. Untreated wound that becomes life-threatening: three minutes. Kidney failure: three minutes. He examines his patients inside and out, touches their bodies, comforts and consoles them, and holds their hands on what is often the worst day of their lives. Like them, he grew up on the South Side; this is his community and he grinds day in and day out to heal them.
Through twenty years of clinical practice, time as a White House fellow, and work as a healthcare entrepreneur, Dr. Fisher has seen firsthand how our country's healthcare system can reflect the worst of society: treating the poor as expendable in order to provide top-notch care to a few. In The Emergency, Fisher brings us through his shift, as he works with limited time and resources to treat incoming patients. And when he goes home, he remains haunted by what he sees throughout his day. The brutal wait times, the disconnect between hospital executives and policymakers and the people they're supposed to serve, and the inaccessible solutions that could help his patients. To cope with the relentless onslaught exacerbated by the pandemic, Fisher begins writing letters to patients and colleagues-letters he will never send-explaining it all to them as best he can.
As fast-paced as an ER shift, The Emergency has all the elements that make doctors' stories so compelling-the high stakes, the fascinating science and practice of medicine, the deep and fraught interactions between patients and doctors, the persistent contemplation of mortality. And, with the rare dual perspective of somebody who also has his hands deep in policy work, Fisher connects these human stories to the sometimes-cruel machinery of care. Beautifully written, vulnerable and deeply empathetic, The Emergency is a call for reform that offers a fresh vision of health care as a foundation of social justice.
Editorial Reviews
"The Emergency is graphic and gut-wrenching, as it should be. It is an undeniable call for a just health-care system, as it will be."-Ibram X. Kendi, author of How to Be an Antiracist
"With scalpel-like precision and searing patient stories, Thomas Fisher exposes the battlefield of medicine and the scarring-and often fatal-wounds of inequality. The Emergency is a bat call. Health care doesn't care, inequality kills, and we must do better."-Dr. Mona Hanna-Attisha, author of What the Eyes Don't See
"The Emergency is a doctor's-eye view of the layered crises afflicting a single Chicago community and the entire nation that surrounds it. By turns brutal and beautiful, this is a tale of life, death, and the people whose efforts often determine which of those two will prevail."-Jelani Cobb, co-editor of The Matter of Black Lives
"Tired of reading about COVID-19? Don't make the mistake of missing the best book about it to date. The Emergency is Thomas Fisher's memoir of the first year of the pandemic's grip on Chicago's South Side, where he grew up and where he battled the disease, along with every other ailment and injury that reached his emergency room. This is no past-tense memoir but a gripping account of events as they happen. It's beautifully rendered in the present tense and leavened by a series of letters he composed to, and in honor of, his patients. But this is also a book about our country, a wrenching and tender reflection on an aphorism Fisher invokes: When America catches a cold, black America catches pneumonia. It won't take you long to read this fast-paced account, but you won't forget it anytime soon."-Paul Farmer, M.D., author of Pathologies of Power: Health, Human Rights, and the New War on the Poor
"Riveting . . . [Fisher] eloquently captures the intensity of the situation . . . and shares heartrending stories of victims. . . . The result is a powerful reckoning with racial injustice and a moving portrait of everyday heroism."-Publishers Weekly (starred review)
"Dramatic . . . well written and compassionate . . . a persuasive, sympathetic . . . insider's report on a broken system."-Kirkus Reviews
"With scalpel-like precision and searing patient stories, Thomas Fisher exposes the battlefield of medicine and the scarring-and often fatal-wounds of inequality. The Emergency is a bat call. Health care doesn't care, inequality kills, and we must do better."-Dr. Mona Hanna-Attisha, author of What the Eyes Don't See
"The Emergency is a doctor's-eye view of the layered crises afflicting a single Chicago community and the entire nation that surrounds it. By turns brutal and beautiful, this is a tale of life, death, and the people whose efforts often determine which of those two will prevail."-Jelani Cobb, co-editor of The Matter of Black Lives
"Tired of reading about COVID-19? Don't make the mistake of missing the best book about it to date. The Emergency is Thomas Fisher's memoir of the first year of the pandemic's grip on Chicago's South Side, where he grew up and where he battled the disease, along with every other ailment and injury that reached his emergency room. This is no past-tense memoir but a gripping account of events as they happen. It's beautifully rendered in the present tense and leavened by a series of letters he composed to, and in honor of, his patients. But this is also a book about our country, a wrenching and tender reflection on an aphorism Fisher invokes: When America catches a cold, black America catches pneumonia. It won't take you long to read this fast-paced account, but you won't forget it anytime soon."-Paul Farmer, M.D., author of Pathologies of Power: Health, Human Rights, and the New War on the Poor
"Riveting . . . [Fisher] eloquently captures the intensity of the situation . . . and shares heartrending stories of victims. . . . The result is a powerful reckoning with racial injustice and a moving portrait of everyday heroism."-Publishers Weekly (starred review)
"Dramatic . . . well written and compassionate . . . a persuasive, sympathetic . . . insider's report on a broken system."-Kirkus Reviews
Short Excerpt Teaser
I
February 2020
We had been waiting for the virus to appear in our ER, but when it did, a heavy pall still fell on the department. Unmasked nurses with long faces spoke in hushed voices and laughed nervously as the patient was directed to Room 41, a negative pressure room that had been designed in 2015 to contain Ebola. The negative pressure in the room keeps the patient's air from contaminating the rest of the department, and the room has a window and microphone in the wall so that we can communicate with the patient while remaining safe outside. Before I entered the antechamber between the common ER hall and the room, I put on a yellow gown, an N95 mask shaped like a duckbill, and a disposable plastic eye shield that I placed over my glasses. The nurse, Fred, was similarly protected, and together we leapt from the safety of the boat into the dark abyss.
I first met the leviathan on New Year's Eve less than two months earlier. "China investigates outbreak of atypical pneumonia that is suspected linked to SARS," tweeted Agence France-Presse on the morning of December 31, 2019. At the time, I had been following foreign media for human signs of the flu that was culling a third of Asia's hogs. But this was not swine flu. Rapidly spreading and deadly infections threaten everyone who works in emergency rooms. We fear the day that a panicked traveler shows up with a high fever and an unusual rash. In the time that it takes to figure out what's going on they would be able to infect all the nurses and doctors who try to help. That nightmare keeps me vigilant for deadly viruses and outbreaks of hemorrhagic fevers no matter where they are on the globe, but so far, I had only experienced misses.
In 2001, when anthrax spores were mailed to politicians and journalists, our waiting room filled with healthy patients worried that they had been exposed to a "white powder." Thirteen years later Ebola swept the world, and I drilled donning and doffing head-to-toe protective equipment for the seemingly inevitable febrile patient bleeding from their eyes and nose. As this unusual pneumonia bloomed into tens, then hundreds of cases, my curiosity turned into something else: fear. When The New York Times took note in a January 8, 2020, article nestled deep within the global health section, I forwarded the item to friends along with a caveat: "This may not be a looming pandemic, but when the next one occurs, this is how it will start."
All of January and most of February elapsed before the first symptomatic patient arrived on the South Side, where I worked as an emergency room doctor at the University of Chicago. By then the coronavirus was dubbed COVID-19 and had infected people on every continent. At last, in late February, a febrile traveler named Terri came to us with a cough and a story. A flight attendant had coughed in her face on her way to Seattle, a city already besieged by the virus. As Seattle's ICUs swelled with infected people, Terri, a middle-aged businesswoman, shook hands in meetings and dined with clients. On the flight back she broke into a fever and developed a hacking cough. After googling "best hospital in Chicago," she grabbed a cab from Midway and came directly to our Emergency Department.
Terri coughed behind her blue surgical mask but greeted Fred and me in good spirits. Dwarfed by the proportions of Room 41, a room designed to accommodate a dialysis machine and a ventilator, she lay semi-reclined, red-faced and sweaty on the gurney. As she was complaining of body aches and nausea, I made a call to the hospital epidemiologist and ordered tests for the virus, a chest CT, and an admission to the hospital to keep her isolated until we confirmed her illness.
Terri's vital signs remained stable despite a fever that Tylenol did not break. I could hear her cough through the closed double doors on her room-each time, my shoulders tensed. We tested our infection precautions every year, but even so, Fred forgot to take off his protective wear when he returned to the ER from the murky depths of Room 41. While he was sending blood to the lab for tests, Fred left the isolation room door open, setting off a squealing alarm. Sweating and nervous, he apologized repeatedly for these miscues. I told him that it was okay, but we both knew these social graces were meaningless. The virus doesn't care about our apologies or forgiveness. Diagnosing and treating an illness we'd never seen before while keeping our lungs and mucus membranes safe was going to require vigilance and stamina.
A week later, Americans awoke to a society unraveling in the wake of the monster's cross-country frenzy. As the infection spread, businesses reduced hours, then closed altogether and laid off workers....
February 2020
We had been waiting for the virus to appear in our ER, but when it did, a heavy pall still fell on the department. Unmasked nurses with long faces spoke in hushed voices and laughed nervously as the patient was directed to Room 41, a negative pressure room that had been designed in 2015 to contain Ebola. The negative pressure in the room keeps the patient's air from contaminating the rest of the department, and the room has a window and microphone in the wall so that we can communicate with the patient while remaining safe outside. Before I entered the antechamber between the common ER hall and the room, I put on a yellow gown, an N95 mask shaped like a duckbill, and a disposable plastic eye shield that I placed over my glasses. The nurse, Fred, was similarly protected, and together we leapt from the safety of the boat into the dark abyss.
I first met the leviathan on New Year's Eve less than two months earlier. "China investigates outbreak of atypical pneumonia that is suspected linked to SARS," tweeted Agence France-Presse on the morning of December 31, 2019. At the time, I had been following foreign media for human signs of the flu that was culling a third of Asia's hogs. But this was not swine flu. Rapidly spreading and deadly infections threaten everyone who works in emergency rooms. We fear the day that a panicked traveler shows up with a high fever and an unusual rash. In the time that it takes to figure out what's going on they would be able to infect all the nurses and doctors who try to help. That nightmare keeps me vigilant for deadly viruses and outbreaks of hemorrhagic fevers no matter where they are on the globe, but so far, I had only experienced misses.
In 2001, when anthrax spores were mailed to politicians and journalists, our waiting room filled with healthy patients worried that they had been exposed to a "white powder." Thirteen years later Ebola swept the world, and I drilled donning and doffing head-to-toe protective equipment for the seemingly inevitable febrile patient bleeding from their eyes and nose. As this unusual pneumonia bloomed into tens, then hundreds of cases, my curiosity turned into something else: fear. When The New York Times took note in a January 8, 2020, article nestled deep within the global health section, I forwarded the item to friends along with a caveat: "This may not be a looming pandemic, but when the next one occurs, this is how it will start."
All of January and most of February elapsed before the first symptomatic patient arrived on the South Side, where I worked as an emergency room doctor at the University of Chicago. By then the coronavirus was dubbed COVID-19 and had infected people on every continent. At last, in late February, a febrile traveler named Terri came to us with a cough and a story. A flight attendant had coughed in her face on her way to Seattle, a city already besieged by the virus. As Seattle's ICUs swelled with infected people, Terri, a middle-aged businesswoman, shook hands in meetings and dined with clients. On the flight back she broke into a fever and developed a hacking cough. After googling "best hospital in Chicago," she grabbed a cab from Midway and came directly to our Emergency Department.
Terri coughed behind her blue surgical mask but greeted Fred and me in good spirits. Dwarfed by the proportions of Room 41, a room designed to accommodate a dialysis machine and a ventilator, she lay semi-reclined, red-faced and sweaty on the gurney. As she was complaining of body aches and nausea, I made a call to the hospital epidemiologist and ordered tests for the virus, a chest CT, and an admission to the hospital to keep her isolated until we confirmed her illness.
Terri's vital signs remained stable despite a fever that Tylenol did not break. I could hear her cough through the closed double doors on her room-each time, my shoulders tensed. We tested our infection precautions every year, but even so, Fred forgot to take off his protective wear when he returned to the ER from the murky depths of Room 41. While he was sending blood to the lab for tests, Fred left the isolation room door open, setting off a squealing alarm. Sweating and nervous, he apologized repeatedly for these miscues. I told him that it was okay, but we both knew these social graces were meaningless. The virus doesn't care about our apologies or forgiveness. Diagnosing and treating an illness we'd never seen before while keeping our lungs and mucus membranes safe was going to require vigilance and stamina.
A week later, Americans awoke to a society unraveling in the wake of the monster's cross-country frenzy. As the infection spread, businesses reduced hours, then closed altogether and laid off workers....
