Nursing Book Club

The Emergency by Thomas Fisher

A pandemic memoir and personal look at racial disparities in healthcare

The Emergency: A Year of Healing and Heartbreak in a Chicago ER is in part the memoir of a busy doctor, working impossibly long hours in the midst of a deadly pandemic and trying to keep his relationships afloat in the little free time he had. It’s also a sobering commentary on the failings of the healthcare system in the U.S.

The book has an interesting format. The numbered chapters describe the author’s firsthand impressions of working under the new COVID-19 protocols. (These will be all too familiar to nurses, but it must be hard for anyone unfamiliar with the protective gear to imagine being able to do your job at all, much less to be able to offer empathy to friends or patients.)

Following these chapters is a letter addressed to one of his patients, attempting to offer an explanation for the treatment — or lack of treatment — they received. The author looks to his own history for examples of racism, which to him is at the core of the disparities in American healthcare.

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Unequal Care

Thomas Fisher is Black and came from the South Side of Chicago, so he thinks of the hospital’s patient population as his people. Yet, forces beyond his control often prevent those patients — including members of his own family — from enjoying equal health advantages.

Through Fisher’s personal narrative, we see just how pervasive racism is in the American healthcare system. Black people live shorter lives, have more chronic illness, experience more violence and get inferior care.

As Fisher remarks, “Black people do not merely have shorter lives than their peers, their lives are more physically agonizing.” Patients lacking insurance can’t get the same treatment, asthma patients can’t afford inhalers and patients with wounds can’t get follow-up care.

Fisher explains that hospitals’ fancy mass-marketing campaigns are really looking for patients with good insurance, and often become just another way of keeping the poor waiting. While he was an administrator, his hospital planned to implement a policy fast-tracking ER patients with insurance, leaving even fewer beds and even longer wait times for the uninsured. He struggled with what was good for the hospital’s bottom line versus what was good for his patients.

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The book’s final section is the most heartbreaking: a letter written to the author’s mother, who proudly went to her son’s hospital (on his day off) and got a misdiagnosis which left her in pain. Fisher describes his anguish at the care his mother received before she was discharged and went to another hospital.

A Frightening Assessment

The Emergency shows us the chaos of a busy ER when one severe illness is monopolizing all the resources. Most of us already know what that’s like, and we’re all too familiar with our public health system’s failure to effectively cope with the pandemic.

It’s Fisher’s insights into that period and his commentary on our health system as experienced by minority patients, that are most valuable — and his assessment is frightening. As the author says, “The health care chasm is a feature of white supremacy and American capitalism.” Those are powerful words to ponder.


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