After two decades in the ER, Thomas Fisher encountered a true emergency that seemed all-encompassing but was just the tip of the iceberg. Reflecting on his experiences on the front lines of one of America's busiest urban hospitals during the COVID-19 pandemic, he realized that his community's literal and metaphorical ills--and those of much of America--are unlikely to heal themselves. Find out how getting to exhaustion and witnessing everyone else's can sometimes provide the energy necessary to take on new challenges.
After two decades in the ER, Thomas Fisher encountered a true emergency that seemed all-encompassing but was just the tip of the iceberg. Reflecting on his experiences on the front lines of one of America's busiest urban hospitals during the COVID-19 pandemic, he realized that his community's literal and metaphorical ills--and those of much of America--are unlikely to heal themselves.
In this episode, find out from Thomas getting to exhaustion and witnessing everyone else's can sometimes provide the energy necessary to take on new challenges.
About This Episode’s Guest
Thomas Fisher is an emergency medicine physician from the south Side of Chicago whose first book The Emergency: A Year of Healing and Heartbreak in a Chicago ER was named one of Time Magazine's "100 Must-Read Books" of the year. He is currently running for election to serve the people of Illinois' 7th Congressional District. You can find more about his campaign at thomasfisherforcongress.com.
Thomas Fisher:After the pandemic, it was so clear to me that we are really here to love one another. Like all of the rest is window dressing, and the relationships that I have now are rich and deep and authentic. Otherwise, why? What are we doing, right? Why are we wasting our time?
Leslie Jennings Rowley: After two decades in the er, Thomas Fisher encountered a true emergency that seemed all encompassing, but was just the tip of the iceberg. Reflecting on his experiences on the front lines of one of America's busiest urban hospitals. During the COVID-19 pandemic, he realized that his community's literal and metaphorical ills, and those of much of America are unlikely to heal themselves. Find out how getting to exhaustion and witnessing everyone else's can sometimes provide the energy necessary to take on new challenges on today's Roads Taken with me, Leslie Jennings Rowley.
So today I'm here with Thomas Fisher and we are going to talk about how getting close and being home lets you look at things really carefully and maybe give tough love when needed, I think. Um, but at any rate, we're gonna talk about lots of different things. So Tom, it's just lovely to have you here.
TF: Thanks so much. It is a pleasure to be invited and to talk to you and our colleagues. It's both been a long time and also it feels like no time at all since we've been together.
LJR: That's right. It's amazing. So when I first talked to a guest for the first time on this program, I asked two questions and they are these, when we were in college, who were you? And when we were getting ready to leave, who did you think you would become?
TF: You know, when we started college, we were 18 and. While at the time I felt I knew so much and I did. Um, when I talked to 18 year olds, they also feel like they know so much. And from my perspective, I don't think that they do not because of their lack of knowledge base or reasoning capacity, but because the lessons of life are not in a book.
LJR: Right.
TF: And I think that when I was entering college, I had a fire and also a naivete. I was coming from Chicago. I went to Kenwood Academy, which is a public high school on the south side, and we started college in the fall of 1992, which was a long time ago. Don't remind me, but in that moment, Chicago was very different than it is today in a lot of different ways. I mean, all of American cities have become much wealthier and gentrified. I grew up in a very middle class community and my high school was 2000 people. Our class at Dartmouth was 1000 people. My neighborhood in Hyde Park was 25,000 people. Hanover was smaller than that probably.
LJR: Oh yeah.
TF: So when I got to college, I sort of felt like I knew a lot of stuff. I was going into the woods in order to learn the tools that I needed in order to be successful in a way that is like cliche. To have the resources that are req…to have the money, not just resources, but money and time required to live prosperously. I sort of had a very cliche image of what that looked like. I would be a doctor, I'd have, you know, a thriving practice of some kind. I had no idea I would have a nice wardrobe, two kids, a wife and be sort of. Privileged in a way that made sense to an 18-year-old who looked at people who were successful based on their. Car and leisure time.
LJR: Right. And the idea that we were striving to do that, I mean that we were fed that American dream.
TF: Oh, for sure. And ivy league and all the things. Right. And then I also come from this black tradition, which is you need to get an education.
LJR: Mm-hmm.
TF: You need to contribute back to your community. You need to participate in a constructive way. And an Ivy League education was, it was the education and the brand, but it also then allowed for you to be a prominent member who could make those contributions. And you know, there were terms like, oh, you need to give back. But you know, my mother was a school social worker. I come from folks who, you know, who stood up through the civil rights era and who were, who spoke clearly about what this country is and is not. And so part of it was to gather the tools to be effective in that alongside this sort of material construct of success. And I had no idea how to do that or what that meant, but I think I had the perspective that, okay, this is step one. And I was also very happy to, like, when I went to Dartmouth, that was what college was supposed to look like. I mean, Hanover's gorgeous. It's a very campusy campus.
LJR: Mm-hmm.
TF: When you get up there in the fall and the leaves are changing, it looks like the hills are on fire. It's special. And so I felt like, okay, I'm here to perform. I'm here to soak it up. I'm here to be a full participant, and then I'm here to ensure that my next step builds on this. And you look at it now and you realize, okay, you graduated at 22, you still don't know anything. Right?
LJR: But we thought we did.
TF: Oh, we were sure we did.
LJR: Mm-hmm.
TF: And that next step that you make. It's just one of like many steps you're gonna make. I don't know if you felt this, but I sort of had this idea that if you don't leave and have some step that you can brag about, you failed.
LJR: Oh, yeah.
TF: Yeah. Like you couldn't just say, well, I don't know what I'm gonna do. I'm gonna find a job, or I'm gonna take a year off before I apply for X or Y people are like, Hmm, you must have a 2.0 GPA. Right. Or, good luck to you. Good luck. Yeah. Yeah. Oh, mm-hmm. Sorry about that. And, and now you look back and you're like, that doesn't matter.
LJR: Yeah. But that was the big thing. We didn't know.
TF: We didn't know it didn't matter. Why didn't we know that? Shouldn't we have been told that by our sort of…
LJR: Well, that's what this show is about. We're trying to get younger people to know that this is the winding path is where it's at. Yeah. It's, it's what we've been doing. So that said, you did know you wanted to be a doctor. You did know you wanted to be, go give back. Was this a straight path for you?
TF: Right after, I graduated and went directly to medical school and I felt, as I just described, some pressure to do so. Personal pressure. Nobody was saying, you have to do this. Right? Nobody was, was threatening me or there was just like, I felt a personal pressure to achieve these goals. I have to go from one step to the next. And so I got into medical school senior spring or maybe late senior winter. You know when, when the applications happen and I went and when I got to medical school. So I went from Dartmouth to the University of Chicago for medical school. When I got to medical school, many of my classmates had taken significant time off. I had one classmate who was in her thirties. Hmm. They had very different perspectives, and I think that I had this because of all of the pressure that I think was both experienced and imposed. You know, I don't think I performed as well as I could have in every way because instead of just being in the moment and saying like, what can I learn here and being curious and growing and I did a lot of challenging things, I like definitely got outta my comfort zone in many ways.
But when I got to medical school, I sort of relaxed. It was pass fail. It became clear your education was your own. And I also realized like my lessons here, I'm gonna need to apply. This isn't just like to not get weeded out to get to the next step. I gotta know this stuff so that when people's care is in my hands, I gotta, I gotta know some things.
It's not just for the test.
LJR: That's right.
TF: And so I think I took a different perspective there that allowed for, so it felt much more comfortable. But I also saw some of my peers living more richly than I was. Not just because they had jobs and had disposable income, but because. They were doing more exploration, personal exploration. They were trying on relationships. They were trying on identities. They were trying on professional trajectories with the comfort of knowing that they could shed them.
LJR: Hmm.
TF: If it didn't fit, once you're in medical school, you're in a pipeline which can be both protective, like you're not gonna be lost into the abyss, but it also means you're not trying anything new. Like you can definitely leave. But you know, I went to a very nurturing medical school where if you're in, you're gonna graduate. If you want to graduate. They're gonna give you the resources and tools that you need in order to be successful. And so I think that there's some stunting of maturation that comes for anybody who spends so much time in this monastic pursuit of medical school or really, you know, people in PhD programs. Like when you're really, really focused it, it means that you're not spending a lot of time on, on other things. But the flip side of it is it was such a gift. I don't think that young me appreciated the intimacy and privilege of being with people and helping guide them through some of the toughest moments of their lives.
I certainly had been a patient when I was young. I think everybody has been right and everybody will be, but I don't think that the meaning and gravity of that comes until you have a few gray hairs. And yet you're making decisions about that when you're, you know, when you're in your early twenties.
LJR: Yeah. And so that path that you took, it was nurturing. You were in a great place. You knew you were gonna get through, you were getting experiences that were testing you. Emergency medicine. Did that emerge as something for you because of you, or was that an external thing that somebody said, Hey, you'd be good at this, or where? Because there is dabbling. I mean not, yeah, not like those other peers of yours, but like you can go and, and try things. How did you (Yeah.) find your way there.
TF: I didn't decide until fourth year. For folks who don't know who might be listening, well, a lot of people come into medical school knowing exactly what they want to do. I'm not sure I knew I had done a primary care fellowship in White River Junction, Vermont once in my junior summer. So, you know, you're on campus Sophomore summer. My junior summer I stayed because I got this C. Everett Coop Fellowship to do primary care work in White River Junction. I rode my bike (Wow.) from Hanover to White River Junction through the hills. I got in good shape. (Mm-hmm.) Or I got a ride with one of my classmates who had a car and so at the time, primary care was being emphasized. I don't know that I loved it, but I know that there was a lot of energy in that direction. I don't think that I discovered emergency medicine until I was almost finished with medical school.
During your third year, you rotate through so many different specialties that you get to dabble, you get to try on. You get to see what, would I like being in an oncologist? Would I like being a pediatrician? How does orthopedic surgery feel? Then after third year, I went to public health school and I went to public health school because between, you only get one summer off in medical school. That's between first and second year and we're encouraged to do research. But what I did instead was a community service fellowship and I helped build a health clinic for black men in Woodlawn, which is the community just south of Hyde Park. And I grew up in Hyde Park, so I was already in the community that raised me and I was, I helped to build a men's health clinic supporting a Robert Wood Johnson clinical scholar who did all this really fascinating focus groups about what people thought about health. And I realized, okay, in medical school I've learned how pathophysiology, anatomy, pharmacology, et cetera, go into the creation or destruction of health for an individual. But then you do this work in the community and you're like, oh, well these people live in context. (Mm-hmm.) Which, you know intuitively. (Mm-hmm.) But I didn't know there was a whole scholarship around that. And so I went to public health school and that was sort of where I landed on the realization that emergency medicine is the right place for me. And I landed on that because at the time, it was the only place where everybody could get care regardless of their ability to pay. It was pre Affordable Care Act. (Mm-hmm.) And so in that way, it's the interface between the community and the healthcare system where. People go because they don't have time to make an appointment where they want a little anonymity, where everything has broken down and they have nowhere else to go where people who don't see themselves as patients go to get care. And in that way it spoke to me and I also got to use my hands and I got to talk to everybody, men and women, young and old, rich and poor. And it just felt like in the zombie apocalypse you had skills. It felt like if somebody asked for a doctor on an airplane, you have skills. It just felt like authentic. Yeah, like a very pragmatic, tangible, real way to work.
And I think I also had an inkling that I might not want to only practice medicine. I certainly learned that in public health school because I started to see models of physicians who practiced, but also were academics, policy makers, executives, parents and they right sized their clinical practice as a component of their identity without it being their entire work world or their entire individual identity. And the ones who were most successful at that were those that were able to find this balance between, okay, I practice and then I have this research question that I'm pursuing or I practice and I have three young kids that I want to be a part of, their youth I practice and I'm building this company, leading this company. Like I didn't see those models until I went away to public health school. And I think that coming back it, I realized that there are so many different ways to be a doctor. I might have an opportunity to pick my own shape it.
LJR: Yeah. Yeah. And I find it so interesting. I think many of us who grew up on. Yeah, like television programs like ER and all that. You know, we think of the ER doctor as like responding to this crisis of the moment. And yeah, almost everything you just said about the field is about community and about. not necessarily, of course, incorporating those crisis of crises of the moment, but really kind of seeing what is bringing people here out of crisis, but maybe not that time-specific crisis, like (Yeah) you know, all the societal pressures at play that the health system is the defacto catcher of. When other things probably should be helping the society or the community before the crisis happens. And so I love that you had that lens of the public health. Then figuring out, okay, this might be the place for me. How many years prior to 2020 did you spend as an emergency room doctor?
TF: I finished med school in oh one, and so I did residency until oh four. I did fellowship until oh six. When I finished residency, I think I started being more of a part-time doc, almost from the beginning because I did a health policy fellowship, so I was practicing it as an attending. And then when I became a junior faculty member, I was practicing it as an attending and doing research, but I was practicing continuously since oh one by the time 2020 came. And I think that the things you describe about this balance between the momentary crisis, the ones that are being captured on TV and documentaries about. The intensity of making high stakes decisions in real time about people's health versus the larger decision making around how people's lives are being lived that lead them to be, ill kind of come in sequence, like when you're in residency, if you don't know how to lead the care team through addressing critical illnesses, you're not an ER doc.
LJR: Right.
TF: There are other people in the room, right? You could be a social worker, but you're not doing the clinical part. You're helping with these bigger picture things, very valuable, important key components of the team, but not the doctor, right? (Mm-hmm.) You actually do have to know how to diagnose and intervene and make high stakes decisions rapidly that have life and death implications with incomplete information and be wrong and alter your decision making path to recover. You have to do that every day. Many times.
LJR: Many times, and I was actually thinking the time clock is actually not so much on this person's bleeding out, but I have a backup of (Yeah.) scores of people in that waiting room. TF: Mm-hmm.
LJR: Right?
TF: Absolutely. I mean, that's the hardest part is I had a patient who passed away in 2020, and we will get to this in more, but they didn't die of the pandemic, I don't think. We don't know. They came in in cardiac arrest. Did the things that we do ran the cardiac arrest code. You know, we're drilled in that we can, we don't do it in our sleep, but we know how to do this. We do this all the time. (Mm-hmm.) We were unable to recover this older woman and you know, you go out and talk to the family and sometimes the family is expecting this. It is occasional that people have cancer or have been sick for a very long time, and so the end is expected. Other times it's a healthy young person who was in a car accident or shot. This was kind of more the former, where the family was expecting it, but you know, there're tears and handholding and you wanna listen and be there, and these are total strangers and it's important to be there. You can't just run through a script, shake a hand, and run out of there even when the waiting room is crushed, because now you've lost your humanity by not honoring their humanity or the importance of what happens in these moments that they'll never forget. Nobody will forget when their grandma passes, when they come to the ER and talk to that doctor, even though it's just, oh yeah, I do this 10 times in a month.
So you've got to really be present and that kind of presence is hard to maintain and cultivate when these losses also weigh on your own experience as a person. (Mm-hmm.) The fragility of your own life and that of your family members. And when you're struggling with your own losses and stressors and yet you still gotta do it, and then you have to go outta that room and see five more people in the next hour. And you have to do that over and over through a lifetime. So it is, I think that early on in my career, I wasn't good at that. I mean, there's a lot of experiences with ER docs who have bad coping practices that involve everything from alcohol and drugs to depression and broken relationships and, you know, financial mismanagement.
You know, ER docs are not always good at that. But then we talk to each other and we get. We grow older and many of the senior docs start are better at it and counsel the young docs. I certainly counsel many of the younger docs about this now, but I think there's something that comes as you as the clinical decision making part becomes more routine, where you've seen suffering and death in every variety and the clinical algorithms are slowing down and you kind of know what happens where you then step back and say, okay, what am I a part of here?
What are the patterns in all this suffering? What are people telling me? Not just in their words, because you do then spend more time listening to their stories, but what do those stories tell me about society? What do they tell me about humanity? What did they tell me about life? And I think I was arriving at that place in my understanding of life when the pandemic hit.
LJR: Yeah. I mean, talk about a test, right? You might feel like, okay. All the, all algorithms. I got those. I'm in this very honed place, and then out of the freaking blue something bigger and (yeah), and at the same time wrapped up in all those other things about why do people get sick and what are the community resources. Plus, I now have a team who normally we're stressed out. This is something well beyond what we can process and deal with. So I learned through you about this through your amazing book, The Emergency.
TF: Thank you for reading.
LJR: I did read, and I read it because you wrote it, but I also read it because I had a friend who was across town at Rush doing the same thing and had told me, and I couldn't, I just couldn't understand. I couldn't understand enormity of that. And your book not only wove wonderful, personal stories, but really kind of peeled back the layers of what the healthcare system is up against or I don't know. So walk us through whatever you can in the brief amount of time, about the pandemic in an emergency setting in Chicago.
TF: Yeah. It was hard.
LJR: Yeah.
TF: For everyone. Yeah. Like, I don't want to, I think it's important to acknowledge how. Literally everybody had their lives disrupted.
LJR: Sure, sure.
TF: People were lonely. People lost jobs. People were isolated, people turned to alcohol. People also turned to friends online. It was just, there was nobody who wasn't touched deeply by the experience. When lockdowns happened in March of 2020, I, I live on the flight path for O'Hare Airport, and I've told this story before where as soon as Lockdowns happen, what went from, you know, a flight every 90 seconds going overhead to zero. Just jarring change, emptying the highways. There was no traffic at any time in Chicago, but the ER also experienced a similar, both slowdown and pickup, right? Like there's a certain amount of people that come to the emergency department for small things. They're small to me, but it's a real medical issue, right? I've been having this nagging stomach ache. Today's the day I can finally see about it, but of course there are no appointments, so I'm gonna go see about it in the ER. That is a real complaint, a real issue. It's not an emergency, but it's a real reason to seek care. Right? We see a lot of that. It is normal in a healthcare system where people don't have access to primary care. We're happy to do it. That stuff just stopped. The people who came in had the virus or were concerned about the virus were shot or otherwise really injured. So it was like this complete transition from, you know, just a wide variety of illnesses and injuries to like very different and focused care. But the biggest change was no matter how bad things get in the emergency department as a doc, you go home. Like you can't stop the clock. You're like, look at three o'clock, my shift is over. No matter how crazy this gets, somebody else will come in, I'll hand it off. They'll be fresh, fresh eyes. I get to go home and recharge. Yeah. What the pandemic did was made us a part of that equation. Like maybe we won't go home or maybe we'll go home and bring the virus with us and infect our family.
LJR: Yeah.
TF: And we had no idea. We'd never seen this. We didn't know how to treat patients. While I seldom use Twitter now, you know, social media I don't feel makes me a better person in general. But then doctors were communicating online about what treatments worked. 'cause we didn't know, right? And we couldn't wait for it to finally publish. We were talking online. We were trading places to where you could get PPE because we didn't have N95s. They were in short shortage all over. I actually got my first respirator from an industrial supplier for, you know, mostly for people who are, you know, building roads and stuff, and they were like, we're out. I told 'em I was an ER doc. They're like, we'll get you one. And they overnighted it to me.
LJR: Wow.
TF: It was just an incredible time of. Stress and anxiety and worry, but it also peeled away everything that doesn't matter and made me understand, well, what's left? It's the people. The people in my life, the patients matter, the relationships we have with one another. Like after the pandemic. It was so clear to me that we are really here to love one another. Oh, yeah. Like all of the rest is window dressing. Okay. And the relationships that I have now are rich and deep and authentic. Otherwise, why? What are we doing, right? Why are we wasting our time? And when you realize that all of this can be snatched away in an instant, and when our time comes, no matter when that is, but in 2020 it felt like it could be any day. It'll be too soon. So what do you need to say to people? What do you need to say to yourself? How do you be present in these moments? How do you then really listen when people are going through this moment of crisis where their family member's unable to breathe and now they're sick too? I poured all of that into my book partially because I was trying to figure it out.
I had a lot of anger. And fear. And as I started writing, I wanted to figure out, well, what is my truest understanding of this? Like not just the emotional, I'm so mad, why did they do this to me? Mm. But who is doing it and what is it that they're doing? And is it really about me? I came to the conclusion that while our healthcare system is predatory and puts profit over people. Almost all of us are trapped in it. Like there was a while where I was like, oh, well this is the administrator's faults. If they would just make different decisions, well, if you changed the roles and made the doctors, the administrators, and put the administrators in the clinical setting, you'd get the same outcome because it's the systems.
They're just as trapped as we are and the patients are trapped as well. Either we start to make decisions as a society based on different morals. Investing in different outcomes or we'll continue to get what we have. Like this is a system that's designed to get exactly what it's giving us, and nobody is happy. Nobody. I mean, there are a lot of people who have comfort and wealth, and when they get sick and injured, would give it all away. In order to be well, yeah. Right? And when they come into the system and the system is unreliable and risky, and they have to figure out the VIP route as opposed to just letting it work, they start to see how precarious this all is.
Or they need an operation and they're not in network. And they have to fight with some unnamed bureaucrat who is literally just doing their job right, but their job creates friction at the time that they're most vulnerable. Nobody's happy about this, let alone the people who have no control of their lives, nowhere to go, and then when they most need care are pushed aside, are made to wait.
While healthcare is not the only setting, you see this, you see this in housing. You see this in education, you see this in the environment. It is the place where it is most glaring because it's in that moment where you most need to be protected, where it is not a commodity. And I think the pandemic made that so transparent to many people, at least in the moment.
Now we've like memory hold it. It's as though it didn't happen. It's as though 1.2 million people didn't die in a year and a half. But we'll have another pandemic. We have 'em about every five years. The Pan COVID-19 wasn't the first pandemic of my professional career. We'd seen
LJR: Mm-hmm. SARS.
TF: We saw Ebola just a couple years earlier and then we saw SARS a couple years before that. They that come every four years. The question is only how big. Mm-hmm. I worry that our lessons are gone and we've descended into petty fighting. Yeah. And political decision making as opposed to the recognition that this is something intrinsic to our humanity, and that if the state doesn't give us food and medicine, well, what's the point?
Yeah. What is the point?
LJR: Yeah. Okay. Okay, so that's a great kind of jumping into pot spot, but let me just kind of put your mind back to finishing the book.
TF: Yeah.
LJR: So you finished the book? That was helping you kind of grapple and process and deal with some fears and angers and reflect on philosophy.
TF: Yeah.
LJR: At what point did you take that and move from, well, that was what I intended to do. I'm proud of that. That's a book to, oh no. That just made me kind of voice these things that I already knew, which were, I have to serve in a different way. I need to try to be part of this, a different part of the solution. I've been a part of a solution person by person. What was that moment for you? Was there a moment for you?
TF: Sort of. I mean, if you read the book, it comes to conclusions about who we are as humans and what our society is writ large. It's a diagnosis, but I don't have treatments in the book. I don't say, and therefore we ought to. And I think part of that was because in the moment I didn't know what to do.
LJR: Right.
TF: I can't say I know exactly what to do now, but I grasped the magnitude of the challenge in that moment and the stakes I. And what I was trying to do in that book was both come to my own understanding of how big this is, that it isn't just, oh, we'll just make some marginal changes along the way and everything. We'll be fine. Or this is some grand misunderstanding. Once we talk more clearly with one another across the aisle, everything will be fine. Like the book allowed me for myself and hopefully for the reader to have those scales fall from their eyes and actually realize that this is. As big as the United States, right? And I don't just mean this moment in the United States, this is as big as the history of our United States. That's how we got here with, um, elevating profit overall else. That's how the segregation of the south side that, um, leaves people prey to exploitation and void of the resources they need. That's how our healthcare system was structured in such a way that. You know, you can allow slogans like margin over mission, overcome the humanity that's required in the moment. Like, this is big, but then it doesn't come down to like, and so all we need to do is, which for some readers is dissatisfying, but for other readers, like I was hoping that people would see what I saw, that we can't ignore it.
Fast forward, I'm like giving talks, the book gets bigger than me. Really quickly, my goal here was partially catharsis and create a conversation with an emergency medicine. But I think there's something about when you tell the truth, people see it, they they or they feel it. The truth is something people experience more than understand.
LJR: Well. And when you have Ta-Nahisi Coates like being your co-partner in getting your word out that that doesn't hurt either.
TF: That doesn't hurt at all. That doesn't hurt at all. But it's still selling today for a lot of, I mean.
LJR: Yeah, unfortunately the problems aren't gone.
TF: The problems will always be here. Maybe not. But as I would talk, people suggested solutions. I quickly understood that the solution isn't something in the past. It's something in the future, right? There is no like, oh, we'll just go back to some better time. Like there wasn't a better time. Like there's always been an opportunity for us to improve this, both this healthcare system, but also this society, this nation, this democracy. Like the future is what we should be optimistic about. And so I started building, like, I was like, well, maybe I need to write another book. I continued to practice medicine. I started working on building healthcare companies that solve problems that everybody needs, like mental health solutions for the elderly, like incorporating family members into care teams.
You know, starting like, let's not wait. Let's just build it. And also I landed on the importance of like centering moral leadership, and I talked about it a lot. Like our budgets are moral documents. The decisions we make when we're in these boardrooms, and I know as 96 ERs we are at that age where we are in charge a lot of places. A lot of places we're in charge. Those decisions have moral implications. And if we are not bringing that into our decision making process, we're just recreating the problems of the past. And so I would go around talking and doing this stuff and folks would be like ‘You should run for office.’ And I took that as a very high compliment and I also felt quite comfortable doing the things that I was doing. And I think that that comfort became discomfort in 2025 when the Trump administration passed the bill that stripped away health insurance from 17 million people. And I was out in the waiting room one day and it's a disaster for all the reasons I outlaw line in the book, people have nowhere else to go. Lives are chaotic. The chaotic lives create illness. Lack of insurance means there aren't enough caregivers in the community. So it's the emergency department, and I'm out here with every bed taken. Beds in the hallways, people in chairs in the hallways, like every space is being used to serve somebody. There's somebody with a bleeding hand in the waiting room after a saw accident, there is a young woman with a desired pregnancy who's bleeding. There's a cancer patient with a fever like who's next? I gotta pick who's next. Yeah. All of these people need to be cared for and, and they're coming in. They're people who have already been waiting six hours in that setting.
You're taking away people's health insurance so that I can get a tax cut. It was unfathomable. Yeah. And then you add to that a Secretary of Health and Human Service who is saying, well, vaccines aren't real. And you say, well, why not? Well, I just don't think they are. This is subtle science. Like nobody, I've been practicing for 25 years.
I'd never seen measles. Why? Vaccines? Right? And now measles is back like I gotta give RFK credit. That's hard to do. You brought back measles. Congratulations.
LJR: Make America measled again.
TF: My God. When I was started practicing, we used to, if a child under 60 days old had a fever, we used to have to do a lumbar, an LP because we had to make sure they didn't have meningitis. We don't do that anymore because the meningitis vaccine, and he's like, ah, let's get rid of that. The science is clear. Why don't you wanna do it? Nah, it's just too many needles like. Why does your opinion matter? Why did the pol…like it started to become infuriating and I couldn't sleep at night. I was no longer comfortable. Right? That discomfort fueled me into the recognition that I'm at a point in my career where I can do more, and this is a moment in history where I didn't wanna look back and ask myself, well, what did you do? Here I'm talking about moral leadership, but what did you do? Well, you know, I was, I wrote another book and I sort of talked to the people who already understood what I cared about and, you know, we were safely protesting online. Like either we stand up or we don't. Right. And I think that, you know, keep in mind I come from a tradition of, you know, black folks stand up. Like there's this tradition of protest starting before the sixties, abolitionists. For the longest time it's been black Americans who have demanded that this country live up to its expressed values that every person's created equal, equal protection of the law.
LJR: But I will say not all protestors decide to run for Congress. That's not the way that many people protest.
TF: No. No.
TF: And yet you are running for the seventh Congressional District in Illinois.
TF: I'm running. I chose to do that because I have so much capacity in ways that few others do. Like the book gave me a platform.
LJR: Mm-hmm.
TF: It helped me think through what matters. It helped me understand that there's a purpose to this. That it isn't like, I'm not doing this because I wanna be a politician. This is public service.
LJR: Right. And it brought people to you who had solutions or have solutions, potential solutions, right?
TF: Exactly. Yes.
LJR: And so you're building that network of people who can really be reliable.
TF: It gave me the network to do it. It gave me the platform to do it. It gave me the time to do it. And then my congressman retired and so like I'd been kind of talking to people about what more I can do. And as I started doing that, people were like, you know you, not only were they saying you should run, but it to a point where they're saying, if you really are serious, we're hearing your congressman's gonna retire. My congressman is Danny Davis. He's like one of the deans of the Congressional Black Caucus. He's been in office since 1996.
LJR: Convenient.
TF: Convenient. I mean, good year.
LJR: It was a good year.
TF: It was. Uh, it is. I feel like the world is talking to me and he's got big shoes to fill, but it's an opportunity, like it also represents generational change. Like in many ways it's our turn. It's our turn. And so standing up in that moment, just in this moment. It just makes sense. And, and then it's, I had this concern that if you like, okay, all these people are like, you should run, but if you throw a party, are people really gonna come? Right. I had a mentor tell me like, if you commit, people will commit alongside you. And it doesn't matter what you're committing to, but if you, when people commit, other people commit alongside them. And it has proven to be true and I've had to learn a lot. In a campaign, like I'm not a politician. I've never run for office. I did work in the first term of the Obama administration on health reform, but that wasn't a campaign. I was working on policy and learned about leadership and I was there during health reform when things were, you know, intense and exciting. But that's not running a campaign. Running a campaign is more like a zero to one, where you are the product. You have to find product market fit, you have to gotta hire a team, you have to raise money, you have to scale, you have to refine as you go.
And so that's what I've been doing. I want people to be enthusiastic and alongside me, but I also rep recognize I'm change, like I'm not a politician. And so I'm interested in other change agents seeing me and aligning and people who want something different to hop on board. And so far so good. The election's March 17th, so it's coming down to it.
It's coming quick, and it has been one of the most compelling experiences of my life. You get to see a side of society that few people get to see. So first of all, emergency medicine is a very unique perspective. (Mm-hmm.) It's one of the few places in society where you interact with people very differently from yourself. Like where do people who are rich and poor, black and white, young and old, all come together at the same time? Like, I don't think there's any place in society like it. It used to be maybe like on public transportation, but that's not the case anymore. Maybe it used to be an airport that's not the case.
Like it's in the ER. Yeah, but then I had this skew to people for who everything is broken down for them, either because of a car accident or a stroke or illness or poverty or homelessness. Like things have broken down. Now I'm getting to talk to everybody where they're trying to figure out how to solve things or of problems they want to have heard or wanna participate in democracy.
And it's just, I've learned more about this city and county in the past, you know, five months of campaigning than in the past 15 years. And it's, you know, it's forced me to grow as well in my understanding of problems, my recognition of the scale of these challenges and the kinds of solutions that are both pragmatic, timely, and necessary.
Because look, we need big change, but we also need to relieve suffering today. And I don't have a whole lot of patience for folk, for the ideas that are like, well, let's just make things worse because then we'll have the opportunity to do more change. Because it's like. You kind of have to look, I'm a doctor. You gotta stop the, you gotta stop the bleeding.
LJR: First do no harm. Right?
TF: Do no harm. Let's talk about it. Exactly. But also that means speaking honestly about how much transformation we need to create a society where people aren't suffering unnecessarily, where we aren't transferring years and quality of life from the poor to the rich. And from the black to the white, like where we all have an equal opportunity to thrive. That has nothing to do with healthcare. You just see it in healthcare. That's where you see the consequences of those policy decisions. But when people have substandard housing jobs that don't offer health insurance or pay well when you've got exposure to violence in ways in some communities and not others, where you know people's lives are just unstable, you see it in healthcare.
But that's a problem with us. Do we protect each other? Do we see each other as similarly human? Do we have a basic standard of living that allow for people to do better than their parents or even as well folks under 40 don't think they're ever gonna own a house. Black folks are leaving Chicago because they don't think they can have the kind of life where they can do better. We deserve more.
LJR: Yeah. Okay. So that 18-year-old that didn't know much, that 21-year-old, 22-year-old, who knew. Only a little bit more. What would he say if you told him, ‘Hey, I'm gonna be a little past 50 and running for Congress?’
TF: He'd think I was crazy for one when I was early on in medical school, we're taught to be apolitical. Like just cold, hard facts. What does the data tell you to do? I had personal political leanings, right? I've always been engaged in the way that our decision making reflects our lives, but like professionally, that's for personal stuff, not work. And I think that I would not have been able to predict. How much the politics of today have changed encroaching on science and facts and our lives.
I also don't think I, I was naive. I, you know, I probably still am naive. I felt so much of this was just a big misunderstanding. You could just change things over in relatively short time. Once people knew better, they would do better. I don't think I fully appreciated the scale of the systems in which we work and, and in some ways it both indicts us, each individually for not participating more, but also alleviate some of it because we're powerless to so much that is happening to us and around us. And I don't think I fully appreciated that then. And I think if I had a clear-eyed view of what it took to campaign or to fight, I'm not sure I would've started this campaign. It's hard. It's worth it, but it's hard and I think that that kind of, you know, optimism that you can actually do it, that I could be one of the people actually doing it has guided me through so many of these decisions and is, and is continuing to guide me now. And I, I guess I wanna hold onto that component of it, but when I was 20, 22, 26. I definitely had a level of optimistic naivete about what it would take to make change that I know will con continue to confront the work that I do. But also I have the recognition that this is generations long work. Yeah, that in some ways has been handed to me, and I don't expect to see it all solved in my lifetime. And then I will hand it on to the next. And what I'm hoping is that we have more generations that see them as a part of perfecting this society, this democracy, these communities, and are willing to fight for it and make sacrifices so that we can all have more. And better lives and social cohesion depends on it and so does our humanity. Like if you believe, like I have clearly seen that we have one shared humanity, all of us, you have to honor that. Like you can't unsee it once you've seen it, and it's right in front of us all the time. And there's all these structures that keep us from embracing the fact that we are all one. But once you see it, you can't unsee it. And then you, you have to do something. Yeah, you have to.
LJR: Well, I'm so glad you're trying to do something and I do hope you hold onto that optimism. It will serve you and the rest of us Well I hope. Thanks Leslie. And uh, we'll be looking to Chicago not just to see the river turn green on March 17th, but to see how you're doing and, hope you'll keep us posted. So thanks so much for being here.
TF: Thanks for having me.
LJR: That was Thomas Fisher, an emergency medicine physician from the South side of Chicago, whose first book The Emergency, A Year of Healing and Heartbreak in a Chicago ER was named one of Time magazine's, 100 must-read books of the year. He's currently running for election to serve the people of Illinois's seventh Congressional District. You can find more about his campaign at ThomasFisherforCongress.com.
We aren't running for anything this year, but we're not running from anything either. When classmates raise their hand to say they'll share a story, Roads Taken is there, even if it requires dusting off the recording gear and remembering how to do this. For longtime listeners, thanks for keeping us in your feeds. And to new folks: Welcome. Be sure to check out our archive of over 160 episodes at RoadsTakenShow.com where you can see great pictures of our guests and check out the transcripts and show notes. And we'd just love it if you would subscribe or follow the show so you won't miss any of our upcoming guests. And me, Leslie Jennings Rowley, on Roads Taken.