Is There a Doctor in the House?

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The trauma of ER is not just medical. Mike Gonzalez gives a diagnosis.

You know before it starts that one person will die and one or two be saved, that a group of people you vaguely recognise from the bus stop will mill around in the background, that it will rain unseasonally, or snow, that Carter will agonise and Dr Green and his surgeon partner will barely hold their lives together. You know that some group of people will arrive bleeding and broken wearing Viking helmets or the togas of a gospel choir. And you know that everyone will talk at once, probably in several languages, and that the doctors and nurses will slam electrical paddles on someone's chest and shout for injections whose names you can't quite catch and stare miserably at X-rays which, from the chair where you're sitting, look like overexposed aerial views of the Blackwall Tunnel.

What is it about ER and programmes like it that defies every ratings war? It isn't like it used to be when Dr Finlay always found time to fill a pipe and discuss the evening's fishing before rescuing the dying shepherd from the stream where his foot was stuck in a rabbit trap. Then there were his younger American equivalents who wore those white tunics just recently arrived from the laundry--Ben Casey and young Kildare. For a while the nurses were the selfless nightingales who briefly replaced the maternal care that in the end was our best hope.

In the Emergency Room (ER), on the other hand, the laundry doesn't get done, the blood spurts in rising columns, needles are weapons and everyone's in pain--from the patients to the doctors. There's an urgency, a despair, a sense of a world full of threat and menace. Everything here seems to hang by a thread and only the experts, the people with this curious knowledge that is expressed in a language as mysterious as the liquid in the bottles that hang everywhere, stand between us and disaster.

At one level, the ER faithfully describes this paradoxical world of endlessly refined technology, on the one hand, and vulnerability and powerlessness on the other. In this wild rushing between emergency and emergency, between one trauma and another, there's no time to explain, to understand, to plan some safer route through this dangerous city. When Green or Elizabeth make it home to the baby, they have made it only for that day; the dependency others have on them is no guarantee of respite. After all, they're stuck too when the subway crashes; inside the ER they have some power, limited and temporary, but outside they are no better armed than the next.

The power of the drama is that week after week they'll face the same ethical and medical dilemmas, they'll perch on the edge of personal disaster. You wait to see if they'll survive this potential catastrophe, knowing they'll face another in the next episode. It's a curious twist that in this counterfeit life the dramas seem so much closer, the sense of impotence and panic so much more authentic, than in all those 'reality shows' that actually show a life controlled, contained, measured by rules and overseen by mediators and judges. In the 'real real' world, like the casualty section, the foremen and the overseers (Big Brother in a word) are never there. They're at a fundraising lunch for the mayor, or they're negotiating tax-evading sponsorships for half a nurse with some multinational that's busy selling tobacco to the Third World. In the 'real real' world the points crack and the computers stop functioning and the shop at the corner has run out of milk. The guys in the ER are a thin line against chaos, but their own lives are often flawed and confused. That's probably what makes them fascinating. But there's another side to this. In the ER the people who fight to achieve some degree of control over their lives--the firefighters, the factory workers, the bus drivers--become powerless. It's significant that in the US they can watch the medics--in Britain they wait outside. But either way they watch and wait, suddenly impotent and afraid. Isn't that the other face of all these programmes and series that deal with emergencies--that we are presented to ourselves as ultimately vulnerable to some arbitrary event, a falling pylon or a bus out of control, that we can't predict or control?

It's true that at the extremes we will have to put ourselves in the hands of others and wait. But I can't help feeling that what that feeds is the conviction that in the end ordinary people must rely on experts speaking in strange tongues and hope that theirs is a real understanding. In an emergency, that may be true. But health, safety, adequate care and knowledge are not provided in a crisis but are part of the shape of our everyday lives--they evolve and are built through time. And there we can have collective control--identify potential dangers, prepare a collective response to them.

It might mean sacrificing the dramatic tensions of the ER, and stepping back from the brink of catastrophe. Still, that would give Carter, Abby, Green, Benton and Weaver a little more time to finally sort their own lives out.