Reflections on “St. Elsewhere”

This Emergency Department scene from the early 1980s’ TV show, “St. Elsewhere” recalls similar scenes from the Phoenix hospital where I practiced emergency medicine. Although we had nobody the stature of Denzel Washington or Ed Begley, Jr., we experienced similar dramas and challenges as depicted in that iconic TV drama. Back then, I had neither the time nor interest to watch more than a partial episode. I was a full-time emergency physician and spent my leisure time in non-work-related activities. Did teachers watch “Room 222”? Did law enforcement officers watch the plethora of police shows on TV at the time?

While stationed in Japan with the US Navy, my family and I often watched TV series on DVD because we appreciated the closed captions and lack of commercials. We got into classic TV drama series like “Picket Fences” and “St. Elsewhere.” Our teenage and twenty-something offspring enjoyed  glimpses of life in the “old days,” which I also found entertaining.

“Did you ever do that, Dad?”

“Actually, yes.” The TV show portrayed both the science and art of medicine realistically, including now obsolete practices like intracardiac adrenaline.

 “No way could someone be in labor and not know she was pregnant! Right, Dad?”

Well, yes, they can. Happened twice in my practice. Both full-term. Truth can be stranger than fiction.

Watching “St. Elsewhere” over twenty years later brought back a flood of memories, poignantly so because quite a few years had passed since I worked a regular shift in the emergency department. Few places on earth put you so close to real life drama, to personal tragedy and triumph. I still remember some patients I saw and treated. My heart still aches as I recall the times I had to tell a family that their loved one had passed. “We did all we could” sounds more trite now that it did then. But I also recall the thrill of feeling a faint pulse where seconds ago there was none, the welcome whisper of a scant breath bringing new oxygen to an almost dying body, the return of a blood pressure as bleeding stops, and the joy of telling an anxious family that all will be okay.

As a young emergency physician, I was hooked on the adrenalin rushes of those challenges and triumphs. The numbers of major trauma and cardiac patients seen and resuscitated made for a good duty shift. (How I pitied my internal medicine colleagues who must deal with chronic, unexciting maladies day after day after day.) As the years went on, I experienced more tragedy than triumph. The dramas of the human condition played out in the ED often reflect the one-to-one statistical correlation of life to death. The only variable is when and how one will die. When that final moment occurred for a patient on my shift, I never felt empowered to change destiny. In death or in life, I was the instrument of a higher power’s plan; no more, no less.

Once I recognized and accepted that reality, I matured both as a physician and human being. Success was no longer measured by blood pressures and respirations, but by the compassion and empathy given to fellow humans in times of life crisis. That was when I became not just a physician, but a real doctor, and where I found the true meaning of my honorable profession; rooted as it is in the Latin word meaning “to teach” and reflected in the tenets of the Oath of Hippocrates.

The young resident physicians portrayed in “St. Elsewhere” are not yet real doctors, although some are further along than others. Their fictional mentors, Drs. Auschlander and Westphall, fully vest their professional value not in themselves but in service to their patients. Their vital role in the drama is to instill those values in the young physicians who follow them. Some will get it, and their careers will mature. Others will not. Just as Chief of Surgery, Dr. Mark Craig still doesn’t understand it and never will. Here too fiction reflects reality, and little has changed from the 1980s.

I  pray that today’s Auschlanders and Westphalls, whoever and wherever they are, will prevail.