One ER Doc’s Journey Through the Pandemic — and the Health Care System

An Arm and a Leg

Society & Culture, Medicine, Health, Health & Fitness, Documentary

4.8 • 1.1K Ratings

🗓️ 7 July 2022

⏱️ 21 minutes

🔗️ Recording | iTunes | RSS

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Summary

Thomas Fisher is an emergency room doc in Chicago. His book, The Emergency, is an up-close chronicle of the COVID pandemic’s first year in his South Side ER.

It also zooms out to tell the story of his journey as a doctor: How his upbringing on the South Side fueled his desire to become a doctor. And how the realities and inequities of American health care limited his ability to help.

He details how the failures of the American health care system — and the racial inequities it perpetuates — leave health care workers with a profound sense of moral injury.

“Over time, when you have this conflict between what you can do and what you're supposed to do—what you wish you could do, what you're trained to do—that creates a moral conundrum….It also leads a lot of people to leave the profession ”

For a time, Fisher himself stepped away from practicing medicine. The journey took him to the executive suite but ultimately landed him back in the ER where he started.

On the street outside the hospital where Fisher works, he sits down with host Dan Weissmann to discuss the book and his search for meaning in the daily sprint of life in the ER.

Here’s a transcript of this episode.
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Transcript

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0:00.0	Hey there. A few months ago I read a book called The Emergency by Thomas Fisher. He's an ER doc
0:06.0	and this is his chronicle of the COVID pandemics first year. And among other things it is full of
0:11.8	piercing descriptions of what he and others call moral injury. That's when there's deep conflict
0:17.6	between what you feel you should do and what your job tells you you have to do. Even when that's
0:23.2	something as simple as helping a patient get a pillow or allow them a visitor or not. He writes that
0:29.6	when he failed to help patients this way, he would avoid their rooms out of shame. Here he is
0:36.2	narrating the audiobook. I close the door and try to forget. No matter what I said, they
0:44.1	interpreted my inability to deliver as mistreatment. And while my avoidance protected me from feeling
0:50.3	like a failure, it added to their perception of institutional neglect. They're right. They're
0:58.0	anger and sadness are justified. And their assessment of my role is accurate. I am a perpetrator
1:05.7	of the system's mistreatment. And I am also a casualty, trying to do the best I can with what I have.
1:13.8	This phenomenon, moral injury, lots of healthcare workers describe it, but not in this kind of
1:19.1	detail. He describes a shift where he's got three minutes with each patient which fulfills
1:24.6	a mandate that patients get seen by a doctor as soon as possible, even if those three minutes
1:29.6	aren't enough to actually help them. Often, they're just a prelude to a long wait for actual treatment.
1:36.0	He describes waking up the morning after a shift, haunted.
1:40.8	Now I remember the time I couldn't remove a bullet or relieve cancer pain, but my patients implored
1:47.0	me to. I knew they required more, but I did only what I could. Was it enough?
1:55.9	I quit asking to suffer and wound something deep inside me. I know it. I just don't know what I can do
2:02.5	about it. I read the emergency this spring and I was like, I want to meet this guy. And he's right
2:13.0	here in Chicago where I live, writing about places I know. I meet up with Thomas Fisher at a noisy
2:18.8	intersection in the middle of the University of Chicago Medical Center's complex where he practices
	...

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