After the South Side’s first COVID-19 patient touched down at Midway airport in February 2020, Dr. Thomas Fisher received them at the University of Chicago Medical Center (UCMC). Within a matter of weeks, the pandemic tore through the city and, in particular, the South and West sides.
In “The Emergency,” his memoir published this March, Fisher immerses readers in UCMC’s emergency room over the course of the COVID-19 pandemic.
Throughout the winter and spring of 2020, an already-high demand for emergency services on the South Side, combined with coronavirus and a surge in violence, overwhelmed Fisher’s ER.
“The beauty of emergency medicine is the way an entire team can enter a flow state — perfect immersion and focus with no gap between thought and action,” writes Fisher. Of course, with only three minutes to address each patient, you lose the ability to give full attention to the unique circumstances of each case. “I am flowing but they want to be something more than a blur.”
“If you look at physicians around the country who were struggling against the deluge of sick people coming in from the pandemic, you'll see us in a moral conflict struggling with this gap between what we want to do and are trained to do, and what we actually have the ability to do,” Fisher said in an interview with the Herald.
Staffing shortages, burnout and higher COVID-19 case rates among doctors and nurses have led to a nationwide exodus of workers from the field. Fisher is candid about the limitations he has come up against in the ER, and his urge to do more is felt throughout the book. He writes letters to his patients, in which he says all the things he wishes he had time to share during his rotations. It’s in these epistolary chapters, set alongside the more intense day-to-day action of the emergency room, that Fisher dives into the intricacies of the healthcare system, its challenges and inequities.
Fisher is a South Sider through and through: He grew up in Hyde Park, returned for medical school at the U. of C. and spent over a decade at UCMC. These roots give him a connection to the community he serves and a special perspective on the racial segregation in Chicago that creates health disparities reflected in the emergency room.
“Racial inequities in health are related to where we live, learn, work and play. Everything from the built environment to wealth, jobs, investment, the environment, all of those things are what shape our lives and therefore shape our health,” Fisher said.
Black and Latino communities on Chicago’s South and West sides are exposed to greater levels of lead and air pollution from nearby scrap yards, distribution facilities and heavy vehicle traffic. These neighborhoods tend to be food deserts, depriving residents of nutrition. There is also a shortage of primary and preventative care physicians, leaving many low-income and uninsured patients relying on emergency rooms for basic care.
The book is filled with scenes from the ER, not only of coronavirus and medical emergencies but also what Fisher distinguishes as systemic problems: diabetes and asthma, kidney failure, untreated injuries, mental health crises, victims of violence and abuse.
Fisher wrote much of the book during the pandemic but also pulled many stories from the years’ worth of journals he has kept. “I think it's important that I tell the truth and share stories that are indicative and common,” he said.
“So much of the violence and chronic illness that we manage allow for an easy aggregation of patients that I've seen over the years that turn into a character, so that I don't violate anybody's privacy, but I'm also honoring the challenges in describing a society from the view of the patient-physician relationship.”
One of these characters is 18-year-old Nicole, who has a sore jaw after being beaten up at school. “Medically this is easy but the circumstances around it are more complicated,” Fisher writes. He rules out a concussion and broken jaw, offering to connect her with a social worker before moving on to the next patient. Though the encounter is brief, Fisher later writes Nicole a long letter apologizing for the wait and lack of time spent with her.
Doctors are trained to do cutting-edge treatment for physical injuries, but they are limited in addressing social determinants such as homelessness and violence. The social workers employed by hospitals do crucial work to support patients after care, but cases still fall through the cracks.
More generally, hospitals must continually balance profit and people. Nonprofit hospitals like UCMC are required to serve uninsured patients and those with public insurance, such as Medicaid. Still, they may restrict treatment for patients who cannot pay and prioritize higher-paying patients.
“In emergency departments across the country, we are facing a frayed safety net and systems that do not have the capacity to care for everybody who needs care,” said Fisher. “In those settings some of the high-tech, niche procedures often take precedence over emergency services for the population.”
At times, Fisher has struggled against these realities. In 2009, early in Fisher’s career as a doctor, hospital leadership announced plans to restrict bed space in the ER to make room for “Patients of Distinction” receiving lucrative, specialty treatments. Fisher was concerned that the plan would segregate the ER and harm the many low-income Black patients UCMC receives, and circulated a memo advocating that treatment be based on the severity of illness. He planned to resign, but when his counterproposal gained support, the leaders who proposed the original plan left instead.
Fisher eventually left too, though he continued to take ER shifts. He spent a year as a White House Fellow at the Department of Health and Human Services under the Obama administration, then worked at an insurance company to implement the Affordable Care Act. Ultimately, when he found he couldn’t effect substantial change in the private sector, Fisher returned to the Emergency Department, where he could improve the health of Americans more directly.
“Even though I'm a son of the medical center, I'm also a son of the South Side,” said Fisher. “It is really important for me to be able to clearly delineate what I think are the true challenges and do that based on our responsibility to take care of folks who live and come from the community that I grew up in.”