Summer 2009 | Issue home

The end of NBC’s ER meant the end of an era for some. Here, two Pitt med-ers—an alumnus and a student—share how a TV show taught them important lessons about becoming physicians.

The NY Times Well blog ran this essay by Ram Gordon (MD ’98) titled
A Doctor Remembers TV's County General.

Fifteen years ago, Ram Gordon and his roommates gathered on Thursday nights to cheer on ER’s John Carter.

FROM LEFT: Frank Nezu (MD ’98), now a urologist in Columbia, Md.; Gordon (MD ’98), now a cardiologist in Philadelphia; and Dan Zlotolow (MD ’98), a hand surgeon in Philadelphia.



As County General Closes

On Sept. 19, 1994, or March 17 in TV time, John Carter began his first shift in the ER at County General Hospital. A third-year medical student, he possessed little knowledge and even fewer skills. The staff ridiculed him for wearing a tailored long white coat, and he nearly vomited when a gruesomely injured patient was wheeled in. By the end of his shift, though, he had inserted an IV, performed sutures, and even assisted in delivering a baby. All in all, it was a pretty decent start to a career, and a TV show.

Carter will be on my mind in a few weeks when I work my own ER shifts as part of the specialty care clerkship at the University of Pittsburgh School of Medicine, my first clinical rotation. When I became acquainted with Carter, on the premiere of the TV show ER, I had just begun eighth grade. Fifteen years later, I have just begun my third year of medical school. So it was with a sense of loss, and gratitude, that I watched the final episode of ER on April 2. At the moment when I would finally get to do what Carter did, after contemplating his world as mine for more than half my life, Carter and his world were no more.

I can’t say that ER made me want to go into medicine. In fact, I spent several years planning not to become a doctor while enjoying the show nonetheless. The medicine always interested me, but it was the characters who practiced the medicine, and those practiced upon, who interested me far more. And occasionally, through watching their experiences, I was better able to understand and honor my own.

Of the 332 episodes of ER, perhaps the one that has proved most poignant for me is “Shades of Gray,” from late in the fourth season. Scottie Anspaugh, preteen son of County General’s chief of staff, has just died of recurrent lymphoma. Jeannie Boulet, a physician’s assistant at the hospital, had become close to him as a private caregiver and helped him make the decision to forego further chemotherapy. At Scottie’s funeral, she sings one of his favorite songs, “Time of Your Life” by Green Day, which was popular that spring.

I’m not sure if I saw the episode when it first aired on April 23, 1998. I was taking the road test for my driver’s license the next morning, my 17th birthday. But I know I saw it as a syndicated rerun early the following January. With my friend Muh-Ren, I watched it at my house while we waited for my mom to make dinner. Muh-Ren was on winter break from her freshman year of college in another state. I don’t recall us thinking much of the episode at the time or of the occasion in general.

As it turned out, that was the last time I ever saw Muh-Ren. In March, she fell ill and was diagnosed with hepatocellular carcinoma, caused by a hepatitis B infection that had been smoldering her whole life, unbeknownst to her. She immediately left college and returned to her parents in her native Taiwan, where she died four weeks later.
She was 18.

In medical school I’ve learned how Muh-Ren got sick and how she died. But it was from the parade of inexplicable tragedies I witnessed on ER that I learned not to ask why. I cannot count how many times I have seen “Shades of Gray” or heard “Time of Your Life” since that evening with Muh-Ren. Every time, I have thought of her. And every time has been a reminder: You do not know when it’s the last time.

I’ve known for a while that I will not be making my career in emergency medicine. And yet, on occasion, I still imagine myself in scrubs, standing at the head of a gurney. As some broken body spurts blood below me, I shout, “I want FFP!  I want platelets! I want packed cells! And dammit, where is surgery?” All the while, I’ll be stroking the patient’s hair and holding her hand. Later, when she has stabilized, I’ll reassure her family and lead them to her bedside for a tearful reunion—just like any number of ER doctors would do.

For a few seconds it’s a mildly appealing fantasy, but then I remember that rapid patient throughput and one-time encounters are not what I want out of medicine. Who I want to be in medicine, though, I was able to observe for 15 years on Thursday nights at 10 o’clock. Sure, they were only characters on a TV show, one in which the story lines and dialogue often seemed less than realistic. But freed from the constraints of real life, the characters could embody ideals. In a profession where the practitioners can become jaded before they even earn their degrees, I’ll gladly aspire to the ideal as long as I can.

Recently, on the first morning of my specialty care clerkship, I went to the Scaife Hall teaching lab to learn suturing on pigs’ feet. A fellow medical student with whom I had waxed nostalgic on the night of the show’s finale was also at the workshop. He turned to me. “See,” he said, “It’s just like ER!”

We laughed. Then I sat down, picked up my needle driver, and started to stitch, struggling all the way through. The next 15 years had begun.

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