Pulling through or pegging outBMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6975.336a (Published 04 February 1995) Cite this as: BMJ 1995;310:336
- Ged Mercurio
The pilot episode of ER is a rollercoaster ride through Chicago County General's emergency room, which lurches from one resuscitation to another and pauses for character moments or patient vignettes. Creator Michael Crichton, author of Jurassic Park, based ER on his experiences as a medical student, and the product has energy, humour, and charismatic characters. Chief resident Dr Mark Green—played by “Goose” from the film Top Gun—is, we are told, “the best.” We were spared seeing him with a patient with rhinitis caseosa and reporting, “Maverick, there are bogeys all over me.” Paediatrician Dr Douglas Ross was established as a heavy drinking heart throb by the subtle device of showing him drunk and bragging about his conquests; surgeon Dr Peter Benton was repeatedly described as a git, and Sherry Stringfield, who played the tough but beautiful Laura Kelly in NYPD Blue, stars as a beautiful but tough physician Dr Susan Lewis. The ensemble is completed by John Carter, the greenhorn medical student.
The pilot omitted a single big story in favour of patient after patient bouncing in and pulling through or pegging out. The narrative style is derivative of Hill Street Blues, relieving the tedium of conventional television storytelling—such as Parkinsonian old lady scalds herself with a boiling kettle, turns up at the accident and emergency department where burns are dressed over chat about her absent family: “Perhaps we should sort out a home help…”
Medical procedures were rendered as accurately as the medium allows. For example, a doctor examined a patient from the left, but it was clear from the scene that having him on the right would have spoilt the background. Since doctors examine from the wrong side in some circumstances technical adviser Dr Lance Gentile will have acquiesced to the director, whereas having an appendicectomy scar on the left is unacceptable no matter what the dramatic considerations (first episode of current series of Casualty). Not pulling the curtains round the bed usually provokes a protest from the Royal College of Nursing, but better to annoy them than to mess up the lighting with shadows and reflections. Also, extras find it hard not to overdo receiving a defibrillator shock, and it is tough to simulate chest compressions without a prosthesis over the actor's thorax. Anaesthetic procedures are impossible to fake, even with good props; like everyone else, ER had to cut away to doctors' faces in order to shoot an intubation. Furthermore, the makers of ER seem aware that a lot of inaccuracies occur in editing: the medical adviser sets up a simulated rhythm on a monitor, it is shot as an insert to be cut into the scene after production, but the adviser is not around when the editor chooses fast atrial fibrillation as an appropriate rhythm for a cardiac arrest due to ventricular fibrillation. I sense that the makers have got the most important stuff right: doctors talk like doctors, and patients act like patients, instead of the fantasy of hospital staff speaking a pidgin jargon while facing melodramatic patients with ludicrously obscure diseases.
My only significant quibble with ER is that it sentimentalised medicine. When Carter felt sick after witnessing some gore, Greene consoled him with “Helping patients is more important than how we feel,” when in reality this statement should have only nauseated him further. In The Good, the Bad and the Ugly Clint Eastwood told Eli Wallach that the two kinds of people are those who dig and those who have guns, while Greene contrasted those who keep their feelings and those who get rid of them. Virtually absent were the cynicism and humour that are as central to Samuel Shem's The House of God as they are to The Houseman's Tale and Cardiac Arrest. All in all, I liked ER a lot. It should appeal to the Hill Street and NYPD audience. The grannies will stick to Casualty.—GED MERCURIO, scriptwriter, “Cardiac Arrest”
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