Last year, I briefly had a job copy-editing digital marketing collateral for a pool of clients that included a personal injury law firm. Every month, they received a dozen blog posts, constructed around keywords that might lead desperate searchers to their services: neck injury, jackknife accident, amputation settlement. The posts were not long, and I am not squeamish, but I could only work through three in a row before I would start to get light-headed, overwhelmed by all the gruesome things that can happen to us and all the gruesome things we can inflict on one another while we’re going through the motions of a normal day.
I get the same feeling if I watch too many episodes of ER in a single sitting, which I learned while trying to binge the series recently. I thought I knew what to expect; the show was the background noise of my childhood. It was always on, it seemed, and when it wasn’t the adults in my life were talking about it. My parents considered it appointment viewing. My godmother missed live airings because she was an ER doctor herself, but she recorded each episode on a VHS tape to watch as soon as she got the chance. Now that I’m an adult, this seems like pathological behavior—not to be dramatic, but I would rather be shot out of a cannon than spend my leisure time watching a TV show about my job—but such was the power of ER. It was such a cultural force that, despite not being a devoted viewer myself, I gleaned its most important details through osmosis. I knew that playing Doug Ross was the genesis of George Clooney turning his rakish charm into piles of money, that a helicopter severed an arm, that Mark Greene (Anthony Edwards) died, and that everyone who’s ever made Julianna Margulies wear a wig since her tenure as Carol Hathaway ended should be tried in federal court.
But mostly I’d assimilated it into my brain as a tame primetime network drama—helicopter amputation aside—and I assumed that it would seem even tamer now. Death and disaster and grievous harm aren’t hard to come by on television today, even on network programming that parents love. The specter of being written off a series hangs over everyone, except maybe Mariska Hargitay and Ice-T on Law and Order: Special Victims Unit. But it’s not the death and disaster and grievous harmthat incite my anxiety if I consume too many consecutive episodes of ER—it’s the randomness of those things, the way the show forces me to grapple with the uncontrollability of our physical and psychic vulnerability, the fact that pain is an inevitable consequence of having a human body that exists among other human bodies. ER is a sadistic show about a group of unstoppable masochists. And in its relentless horrors, it ensures that we know that avoiding pain is no guarantee, that no one—patient or practitioner—suffers in a vacuum. Our pain results from human choices, and its impacts ripple outward. And any effort to control the spread is well-meaning but largely futile.
It’s fascinating, though, to see all the ways these characters try. “24 Hours,” a screenplay reassembled into a two-hour pilot episode that aired in September 1994, covers a single day at Chicago’s County General Hospital. The episode is a revolving door of short narratives, an endless series of attempts to put a lid on chaos that’s already boiled over. Not every chaotic event is of equal urgency: a building collapses; a child swallows the lone key to his house; it snows, then it rains (which is normal for the Great Lakes region but not for pop-culture representations of it). But each of these events reflects the limits of anyone’s capacity to control their day, and, taken collectively, they constitute a relentless onslaught—a flow that cannot be stanched. The pace of the episode is overwhelming, and its longer, slower scenes offer little in the way of emotional or mental reprieve.
In one of those slower moments, high-achieving resident Susan Lewis (Sherry Stringfield) is tasked with telling a middle-aged man that X-rays have revealed a substantial mass in his lung. She’s not entirely confident what the mass is, but she knows there’s no possible reassuring explanation for its presence, no way this news will lead to a positive conclusion. Hedging, she tries to lay out only the facts she can confirm from the X-ray alone, refusing to offer anything resembling a diagnosis or prognosis. It’s the most responsible approach—she’s not a pulmonology expert; what if her assessment proves wrong?—but not the most humane, and the patient tells her as much, calling out her grim expression and demanding more information.
“I have a wife, I have three children. I have a house that is not paid for. I have a mother who has a house that isn’t paid for,” he explains, not desperate, but matter-of-fact. It’s depressing that the financial parts of his reaction are still so relevant 25 years later. And, in referencing a precarious monetary situation, the scene implies that cost was a barrier to seeking treatment sooner, that this situation was at one point preventable but more immediate concerns took precedence. His concern for others—his fear of what will happen to those who rely on him once he can no longer be depended upon—persuades Susan, whose Type A, rule-abiding competence was forged from her own outsized responsibilities to her family.
She responds with her best guess: it’s probably cancer, and he has six months to a year left to live, adding the caveat that “nothing is certain.” He’s so relieved to have this information that he wraps her in a hug, which she awkwardly accepts, trying not to give away her bewilderment. It’s not that this news is better than he expected but that it’s something tangible to hold onto, something that can guide how he thinks and acts going forward. Having that knowledge is enough to give him some sense of control over what happens next; for Susan, anything that isn’t a step toward a cure is a failure, a reminder of her inadequacy.
She’s not alone in placing such unrealistic pressures on herself. Despite Mark Greene’s pilot episode insistence that “helping them is more important than how we feel,” the series focuses obsessively on its practitioners’ feelings—although those feelings are, of course, inextricable from helping patients. The show neither reifies nor rejects the oft-repeated stereotype that all doctors have god complexes; rather, it dissects all the distinct varieties of god complex a care worker might develop. It forces you to understand all the nuances of how and why a person might try to assert dominance over an indomitable universe, and what happens when they choose a life that’s an exercise in repeated failure to realize control. (This is why your favorite ER character says more about you than your birth chart, your Myers-Briggs type, your DiSC score, and your Enneagram combined. The only other cultural-discourse thing that drags the darkness of your psyche further into the light is which Sopranos character you most identify with and your Paul Thomas Anderson ranking. I, predictably, would follow Doug Ross into hell.)
For most of these characters, the relentless exposure to the worst of human experience elicits some terrible behavior—guarded misanthropy at best and unhinged tantrums at worst. Their humor is caustic; their treatment of one another, and occasionally of their family members and their patients, is rude as hell. The show doesn’t ask us to forgive these tendencies—in fact, it often demands that we condemn them, especially when any sort of surliness gets directed toward County Gen’s overworked and underpaid nursing staff—but it does force us to examine their source, and it doesn’t make that information particularly simple or easy to digest. To have any investment in the series, you have to not just hold two disparate statements in your mind simultaneously but understand them as intrinsic to one another: these people are motivated by a desire to correct the world’s injustices. They are also tremendous assholes.
A less complicated show would streamline Peter Benton’s (Eriq La Salle) motivations into simply wanting to be the king of the world—and, to be clear, wielding power over an endless parade of embodied horrors doesn’t make his ego any smaller. But ER gives us a voyeuristic level of detail into why he craves that ego inflation—not with “this asshole is secretly a big softy” sleight-of-hand, but with a detailed portrait of his place within an unpredictable family life and a world that refuses to validate the accomplishments of people of color. Mark Greene’s control-freak tendencies are easier for those around him to cope with, but their small scope almost makes them more tragic: he wants to heal others, but mostly he just wants the capacity to heal himself into a person who’s capable of living a different, simpler life. Others try to lean into chaos as a way to try to learn it and rein it in—like Doug, who’s constantly testing his ability to maintain emotional control in the face of possible vulnerability with risky romantic entanglements and problematic drinking, and nurse Carol Hathaway, who marinates in her feelings of guilt over not being able to do more, to be better.
One notable exception to the deep existential malcontent is John Carter III (Noah Wyle), who begins the series as a third-year medical student who also happens to be a precious baby angel sent straight from heaven. Carter—a kind, sensitive, straight, white man with a trust fund and a roman numeral in his name—is perhaps the most aggressively fictional character who has ever appeared on television, but Wyle’s sweet young face lends credibility to this incredible being and transforms a very obvious audience proxy into an actual character. The arc of Carter’s universe bends toward self-protective misanthropy, of course—but his path traces how a person both does and does not become desensitized through constant exposure to the pain and suffering of others. He stops throwing up during especially gory procedures, sure, but he does not become protected from grief or guilt—though he tries later in the series, first through a painkiller habit and then, later, through full-blown altruism.
But he fails in his efforts to immunize himself from others’ pain as well as his own. Of course he does; we all do. Because no amount of dark humor or egotism or ill-advised romance or substance use or cynicism or self-sacrifice can wall us off from the rest of the world. And no volume of exposure to the vast universe of human suffering, voluntary or not, can make it a fully known and manageable entity. ER isn’t a treatise in favor of radical vulnerability—but it isn’t pro-guardedness propaganda, either. It makes a statement that’s much more terrifying than either of the two options it feels like we’re all bouncing between in these weird, painful times: Should we try to steel ourselves from the chaos that others’ choices can sow, keep things at a distance with irony or self-righteousness or aggression? Or should we lean into the way that our lives are all wrapped up in one another’s, confess the ways we’ve been harmed, and hold ourselves accountable for the harm we’ve done as well?
The former is often easier, and the latter seems more correct. But it would be too simple to declare either option easy or right, and ER suggests that we each need to find our own uniquely unhinged-but-not-too-unhinged way to balance both if we’re going to make it through (relatively) intact. Because being a person in the world is an exercise in constant ambiguity and unpredictability and risk, there’s no correct way to handle any of it—not when interdependence is both its underlying pathology and its cure.